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OBSERVATIONS

ON THE

DISEASES

INCIDENT TO

SEAM

E Y

GILBERT BLANE, M. D. F. R. S.

PHYSICIAN EXTRAORDINARY TO THE PRINCE OF WALES,

PHYSICIAN TO ST. THOMAS'S HOSPITAL,

ANP PHYSICIAN TO THE FLEET IN THE LATE WAR.

LONDON:

Printed by Joseph Cooper ;

And fold by John Murray, No 32, Fleet Street, and by
William Creech, in Edinburgh.

M.PCC.LXXXV.

Nee Medici, nee Imperatores, nee Oratores, quamvis
artis prcecepta perceperint, quidquam magna laude
dignum fine ufu et excercitatione confequi pofTunt.

Cicero,

CONTENTS.

PAR T I.

BOOK I.

CPas;e
OMPREHENDING the Medical Hiftory of the

Fleet, from March 1780, till Auguft 178 1 - 15

CHAP. I.

Account of the Health of the Fleet from March
1780, till July following - - - ~ 15

CHAP. ir.v

Account of the Health of the Fleet from Auguft
1780, till December following - - - o

A 2 CHAP.

iv CONTENTS,

CHAP. III. Page

Account of the Health of the Fleet from January
1781, till July 178 1, both Months included - 44

BOOK II.

Continuation of the Medical Hiilory of the Fleet,
from Auguft 1 78 1, till the Conclufion of the War
in April 1783 ----- fa

CHAP. I.

Some Account of the interval between the Cam-
paigns of 1 78 1, and the Junction of the Reinforce-
ment from England in April 178a - - 6c

CHAP. II.

Account of the Health of the Fleet from the June*
tion of the Squadron from England, till the gene-
ral Rendezvous at St. Lucia, in the beginning of
April - - - - - - --71

CHAP. III.
State of Health of the Fleet in April 1782 93

CHAP.

CONTENTS. v

CHAP. IV.

Page

Account of the Health of the Fleet while it lay at
Jamaica, during May, June, and part of July,

1782 -.-----'- - 104

CHAP. V.

Account of the Health of the Fleet from its leaving
Jamaica on the 17th of July, 1782, till its Depar-
from New York, on the 25th of October following 133

CHAP. VI.

Account of the Health of the Fleet from its Depar-
ture from New York, till the Conclufion of the

War «■ 152

BOOK III.

Of the Numbers and Mortality of different
Diseases fent to Hofpitals, with a General View
of the whole Mortality during the War - 179

PART

v) CONTENTS.

PART II.

Pag«

Of the Causes of Sicknefs in Fleets, and the Means

of Prevention - - - - - 205

Introduction --■----_ ibid

CHAP. I.

Of Air - - - - - - - 2i8

Sedl. I. Of the noxious EfFedls of Land Air ia par-
ticular Situations - , ■.'- • - 220
Sed. II. Of theErFeds of foul Air, from theNegleft
of Cleanlinefs in Men's Perfons — Infection 229

3. Means of preventing the Introduaion of In-"
feaion - - . - . - - - 232

2. Means of preventing the Produaion of In-

feaion - - ----- 244

3. Means of eradicating Infeaion - - 252

Sea. III. Of the foul Air generated in a Ship - 262
— — IV. Means of guarding againft Infeaion and

bad Air ------ 272

CHAP.

CONTENTS.

CHAP. II. *>age

Of Aliment - - - 282

Sea. T. OffolidFood ibid

II. Of Drink - " - - . - - - 300

Of Water ----- 305

CHAP. Ill
OfCloathing - - «. - - -315

CHAP. IV.

Of Exercife ------ ^t

Conclusion - - 326

Appendix - - - 329

Memorial to the Admiralty - - - ibid

Supplement to the Memorial - - - 341

PART III.

Description and Treatment of the Difeafes
moil frequently occurring in Fleets in hot Climates 34^

C H A P. T.

Of Fevers - -

.. - 347

z. Of the infectious Ship Fever

348

2. Of the Bilious remitting Fever

" 3B6

3. Of

viii CONTENTS.

3. Of the Yellow Fever -■-'-'- 396

4. Of the Effects of fome unufual Remedies in the
Cure of obftinate intermittent Fevers - 420

CHAP. II.
Of Fluxes ----- 429

CHAP. III.
Of Seurvy ~ - - - - - 460

CHAP. IV.

Of the Wounds received in the Actions of April
1782 - - - 478

DEDICATION

TO HIS
ROYAL HIGHNESS

Prince WILLIAM-HENRY,
S I R,

FTpi

JL H E following Work is the fruit
of feveral years labour employed in
the Public Service, chiefly under that
great and fuccefsful Admiral, Lord
Rodney, in a feries of Naval Opera-
tions, which have been productive of

B events

ii DEDICATION.

events more glorious than any re-
corded in the Annals of Britain. As
your Royal Highnefs was prefent du-
ring fome part of the fervice which is
the fubject of thefe Obfervations, and
as You have not only honoured the
Sea Service by embracing it as a pro-
feflion, and enrolling your llluftrious
Name among its officers, but in un-
dergoing the dangers and fatigues of
actual fervice, which is fo neceffary to
attain that practical Skill which Your
Royal Highnefs is well known to pof-
fefs, I have, upon thefe grounds, pre-
fumed to lay this Work at Your feet. I
(houid do this with greater fatisfaction,
2 were

DEDICATION* Ui

were it more worthy of Your accep-
tance; but however inadequate my
abilities may have been ta the talk,
it has been my fincere aim to produce
a work of fome utility to that only
Bulwark of our Country, the Britifti
Navy, of which Your Royal Highnefs
is the Pride and the Hope.

Your Royal Highnefs's Permlflion
to infcribe this work to You, and
the perfonal Notice and Protection
with which you have, on. fame pafl
occafions, honoured me, I confide?
as the firft Diftinctions of my life,
and of which I hope ever to ert-
B % tertaitt

j* DEDICATION,

tertain a becoming fenfe, by cheri fil-
ing thofe indelible fentiments of Re-
fpeft, Gratitude, and Attachment,
which are due to Your Royal High-
saefs from

Your Royal Highnefs's
Moft faithful,

Moll obedient, and
Moft devoted Servant,

Gilbert Blane.

London,
May i, 1785.

PRE-

R E F A C

t± A VING been appointed by Lord Rodney
Phyfician to the Fleet under his command*
in the beginning of the year 1780, I deter-
mined to avail myfelf, to the utmoir. of my
abilities, of the advantages which this field
of obfervation afforded* This 1 was led to
do, in order to fatisfy my own mind as a
matter of duty, as well as to find out, if
poffible, the means ,of bettering the con-
dition of a clafs of men, who are the bul-
wark of the ftate, but whofe lot is hardfhip
and difeafe, above that of all others.

B 3 A fleet.

vi PREFACE*

A fleet, convincing feldom of lefs than
twenty mips of the line of battle, and fome-
times exceeding forty, which I attended in
the different fcenes of active fervice in that
diflant and unhealthful region, for more
than three years, has afforded me opportu-
nities of making obfervations upon a large
fcale.

My object has been prevention as much as
cure ; and as the former mull: more particu-
larly depend on a knowledge of the remote
caufes of difeafe, I have collected and arran-
ged all the facts upon this fubject that came
within my reach, considering thefe as the
only grounds from whence the real caufes
of health and ficknefs could be deduced.

In entering upon my employment, the
Commander in Chief gave an order, that
every furgeon in the fleet mould fend me a
monthly return, ftating the prevalence of

PREFACE* vnl

difeafe, the mortality, and whatever elfe
related to the health of the refpeclive
fhips. This was done with a view to enable
me to regulate the reception of men into
hofpitals, fo that each fhip might have a
due proportion of relief, according to the
degree of ficknefs on board, taking care at
the fame time that the hofpitals fhould not
be overcrowded ; and alio to acquaint the
Commander in Chief, from time to time, of
the flate of ficknefs, or the predominance
of particular difeafes, in order to recom*
mend fuch articles of diet, or other means,
as might tend to cure them, or to check
their progrefs. TJiefe returns have ferved
alfo in this work as a method of collecting a
multitude of well-eftabliflied facts, tending
to afcertain the caufes and courfe of difeafe.

While the fleet was in port, I alfo fuper-

intended and vinted daily the hofpitals, of

which there is one at almoft every iflaud on

B 4 the

viii PREFACE,

the ftation ; and having kept an account of
the different kinds of difeafe that were ad*
mitted, and of their mortality, I have in
this way alfo been furnifhed with a number
of fads that may throw light on the hiftory
of human maladies,

Neverthelefs, I do not boafl of having
made great difcoveries ; and every perfon of
a correct judgement mull be aware how dif-
ficult it is to afcertain truths and to draw
fair and folid inferences on medical fubjects.
I have attempted little more than to amafs,
from my own obfervation, and by the affif-
tance of the furgeons of the fleet, a number
of well-eftablifhed facts, and to arrange them
in fuch a methodical manner, as to prove a
ground work for investigation ; and I am
perfuaded that others of more fagacity and
enlarged knowledge than myfelf, may be
able to deduce from them obfervations that
may have efcaped me, efpecially if thefe

new*

PREFACE. i*

new, but imperfect, attempts fhouid come
to be compared with fimilar ones that may be
made by other obfervers in other climates,
and in other circumftances of fervice,

I met with feveral obftacles in infHtuting
inquiries purely medical to the extent I could
have wimed. There is in the firfl place,
from the nature of the fubjecV a great dif-
ficulty attending all practical inquiries in
medicine ; for in order to afcertain truth, in
a manner that is fatisfactory to a mind habi-
tuated to chafb inveftigation, there muft be
a feries of patient and attentive obfervations
upon a great number of cafes, and the dif-
ferent trials mufl be varied, weighed, and
compared, in order to form a proper eftimate
of the real effipacy of different remedies and
modes of treatment.

But berldes this difficulty belonging to
the nature of the fubjecl, there were others

connected

x PREFACE.

conne&ed with the nature of the fervice ;
for the hofpitals were at times fo inadequate,
in point of fize, and fo ill provided with
neceflary articles and accommodations, par-
ticularly during the firft part of my atten-
dance, that my principal care was to re-
medy thefe defects by proper fuperinten-
dance and representation.

A due attention to air, diet, and cleanli-
nefs, is not only more effential than mere
medical treatment, but the fick cannot be
confidered as fit Subjects for evincing the
powers of medicine till they are properly
provided for in thefe refpects. Thefe in-
conveniences were owing in a great mea-
fure to the unufual extent of the. fervice;
for there was a much greater naval force in
thofe feas, at this period, than was ever
before known, and there was of courfe a
proportional want of accommodation for
the fick. Towards the end of the war

thefe

P R E F A C E. xi

thefe difficulties were much obviated, fo
that a fairer field of obfervation came to be
offered.

Another obflacle to my practical inqui-
ries was, that the fleets I belonged to fel-
dom remained more than fix weeks or two
months at any one place, fo that any feries
of obfervations that might have been infti-
tuted was interrupted, and I was in a great
degree deprived of the fruits of them, by
not feeing the event of cafes under my ma«
nagement.

The peace in the fpring of the year 1 783,
put an end to all my inquiries, and particu-
larly prevented me from following out feme
practical refearches. I have ventured, how-
ever, in one part of this work, to give the
refult of my experience in forne difeafes,
more efpecially fuch as are peculiar to the
climate. -

xif PREFACE.

Upon the whole, I have, in the following
work, humbly attempted to follow what I
conceive to be the only true method of cul-
tivating any practical art, that is, to collect
and compare a great number of fads. A
few individual cafes are not to be relied on
as a foundation of general reafoning, the de-
ductions from them being inconclufive and
fallacious, and they are liable to be turned and
gloffed, according as the mind of the obfer*
ver may be bianed by a favourite prepofTef-
fion or hypothecs. It has been my fludy to
exhibit a rigid tranfcript of truth and nature.,
upon a large fcale, and to take the average
of numberlefs particular fads, to ferve as a
ground-work for obfervation ; and I have
endeavoured to analyfe and collate thefe
fads, by throwing the monthly returns that
were made to me into the form of Tables,
as the moil certain and compendious way for
finding their general refult. If the materials
are not fufficiently ample, or if the me*

3 thod

PREFACE, xiii

thod mould be found faulty and imperfect,
let it be remembered, that I had no example
to go by in this field of obfervation. It is
to be regretted, that ages have paffed with-
out any attempts being made to tranfmit re-
gular records of this kind to pofterity. It
would not only be extremely curious, as a
piece of natural knowledge, but would
conduce greatly to medical improvement and
public utility, were we pofTened of fuch
information concerning the caufes and na-
ture of the difeafes prevailing at fea, in va-
rious circumfiances of weather, climate, and
diet, in remote ages and countries, or even
in our own age and country, as might en-
able us to compare them with prefent facts,
and to afcertain more precifely the means of
preventing and removing fuch difeafes.

The method I propofe to follow in this
work, is, Firll, to deliver the hiftory of
the different voyages and expeditions, fo fat-
as

%W PREFACE.

as relates to health, giving an account of
the prevalence and nature of the difeafes and
mortality on board of mips and in hofpitals.

Secondly, To deduce, from obfervations
founded on thefe facts, and alfo from the
former experience of others, the caufes of
ficknefs in fleets, and the means of preven-
tion.

Thirdly, To deliver fome practical obfer-
vations on the cure of the mofl common
difeafes incident to fleets, particularly in hot
climates.

OBSE R~

OBSERVATIONS, &c

PART I.

BOOK L

Comprehending the Medical History of
the Fleet, from March 1780 till Auguft
1781.

CHAP. I.

Containing an Account of the Health of the Fleet

from March 1780 till July following. Five

Ships ©f the Line arrive at Barbadoes from Europe in
March — Join a large Squadron then on that Station
— Their Health compared — Engagements with the
Enemy in April and May producing Hardmip and Ex-
pofure, but little Increafe of Sicknefs - — Method of
colledting the Returns of the Surgeons — Influence
of Situation upon Health in Harbours — Courfe of
the Seafons., and Temperature of the Weft Indies —
The Fleet reinforced in June and July with Ships
from England and North America — Their Health.

JD U R I N G the war, which broke out
with France in 1778, and with Spain in
1779, the Weft Indies was the principal
feat of naval operations, and much greater

fleets

l6* DISEASES OF THE FLEET, I780. *ART !.

fleets were then employed in that quarter of
the world than in any former period.

Though there had been a great fquadron
on the Caribbee ftation during the greater
part of 1779, no phyfician was appointed to
it till the beginning of next year, when
I arrived there in that character with my
friend and protestor, Lord Rodney.

There were then fixteen mips of the line
on that ftation, moft of which had been
upwards of twelve months in the climate;
and they were reinforced at this time by five
more from England.

The fquadron which we found on the
ftation was then extremely healthy, and in
feveral of the fhips there was not a man
unfit for duty. We were told, however,
that they had all been fubject to ficknefs,
particularly to the dyfentery, foon after
their arrival in that climate. Of the five
with which the fleet was at this time rein-
forced, all but the Intrepid, left England
at Chriftmas, making part of the fquadron

which

BOOK i. DiSEx^SES OF THE FLEET., I?80. l"J

which efFe&ed the firft relief of Gibraltar*
under the command of Lord Rodney, who
continued his route to the Weft Indies, in
order to take the command on the Wind-
ward ftation, where he arrived on the 16th
of March. The Intrepid arrived with a
convoy the day before. Thefe five fhips
were all pretty healthy on their paffage*
except the Sandwich and Terrible, in which
a fever prevailed; but they had almoft re-
covered from it before they arrived in the
Weft Indies. A dyfentery broke out in
April in all the (hips newly arrived, and it
prevailed to the greateft degree in thofe
which had been moft affected with fevers
in Europe, namely, in the Terrible and
Intrepid. The Sandwich and Ajax were
alfo affected, though in a lefs degree ; but
the Montagu, though this was her firft
voyage, and though (he was juft off the
flocks, had been the moft healthy of any
of them from the time of leaving England,
and continued fo during all this campaign*
I have not obferved that new fhips are more
unhealthy than others, unlefs they are built
of ill-feafoned timber ; and they have this

C advantage,

lS DISEASES OF THE FLEET, iy8o. PART U

advantage, that there is no previous infec-
tion adhering to them. What may have
contributed alfo to the fuperior health of
the Montagu was the precaution that was
taken when this fhip was firft manned and
fitted out, of Gripping and warning the
men that were brought from the guardfhip
to complete the crew.

The Intrepid, while in England, had been
afflicted with fevers to a moft uncommon
degree ; for, being one of the fleet in the
Channel cruize the year before, almoft the
whole crew either died at fea, or were fent
to the hofpital upon arriving at Portfmouth.
This fhip, after refitting, was pretty heal-
thy for a little time ; but, probably from the
operation of the old adhering infection, fhe
became extremely lickly immediately after
joining our fleet, and fent two hundred men
to the hofpital the firft two months after
arriving in the Weft Indies. Moft of
thefe were ill of the dyfentery.

The Pegafus frigate arrived with the ihips
from Gibraltar, and we have here an in-
stance

BOOK I. DISEASES OF THE FLEET, I?80. I£

ftance of the fuperior health commonly en-
joyed by this clafs of mips over mips of the
line ; for when fhe was difpatched to Eng-
land in the end of April, there had not
been a man taken ill from the time of her
arrival on the ftation.

This feafon was a very active one in the
operations of war; for, beiides the general
battle of the 17th of April, there were two
partial actions in May ; and, from the 15th of
the former month till the 20th of the latter,
our fleet was conflantly in the face of the
enemy's, except for a few days that it was
refitting at St. Lucia after the firfl battle.
This was extremely harraffing to the men,
not only from the inceflant labour neceffary
in the evolutions of the fleet, but by their
being constantly at quarters witri the (hips
clear for action ; for, in that fituation,
- they had nothing to deep upon but the
bare decks, the hammocks and bedding
being employed in barricading the mip,
which is done by placing them in ranges
on the gunwale, to cover the men from
the enemy's grape and fmall mot. Thefe
C 2 hard-

20 DISEASES OF THE FLEET, I^So. PARTI.

hardfhips were productive of fome fick-
nefs, though much lefs than might have
been expected, for the weather is at all
times warm, and it was at this time ex-
tremely moderate and dry. Befides, we
fhall fee in other inftances as well as this,
that, in the ardour infpired by the prefence
of an enemy, men are lefs exhaufted by
their exertions than on ordinary and lefs
interefling occafions.

Almoft the whole of the fick and wound-
ed, to the number of 750, were put on more
at Barbadoes, where all the fleet, except
three mips*, arrived on the 2 2d of May.

I now began to keep regular and metho-
dical accounts of the ficknefs and mortality
in the fleet, though in a manner more im-
perfect and lefs accurate than was afterwards
adopted. I was embarked on board of the
Sandwich, where the Commander in Chief
had his flag, fo that I was always prefent

* Thefe were the Conqueror, the Cornwall, and the
Boyne, which were fo damaged in the hattles, that they
were obliged to bear away for St. Lucia.

with

BOOK I. DISEASES OF THE FLEET, 1780. 21

with the main body of the fleet, whether at
fea or in port.

A form of monthly returns * was adopted,
which, as well as other points of method,
was afterwards improved.

After

* The following may ferve as a fpecimen of thefe re-
turns :

STATE of HEALTH of his Majefly's Ship ALCIDE.
Carlifle Bay, Barbadoes, ifl June, 1781.

Sick now on Board.

Died in the courfe
of lift Month.

SenttotheHofpi-
talin the courfe
of laft Month.

Fevers - - 4
Flux - - - 5
Scurvy - - 26
Catarrh and ~)
Rheumatifm j

Total - 42

Of Fever - 1

Ill of Scurvy 35

REMARKS.

During the courfa of laft month, we had 1 14 of th»

men, who contracted the fcurvy in the late long cruife,

recovered by the ufe of limes, which were procured at

C 3 Montferrat.

2.2 DISEASES OF THE FLEET, I780. PART I.

After collecting the returns for each month,
I made abfhracts of them in tables ; in one

column

Montferrat. A pint of wine, with an equal quantity of
water, made agreeable with fugarand tamarinds, is ferved
to each patient daily. The regimen is exactly the fame
as mentioned lafl: month.

Since we came into port, very few have been feized
with fcurvy, but feveral complain daily of fluxes, and
feverifti complaints, none of which feem at prefent to be
of any confequence.

Four patients have laft month complained of an almoft
total blindnefs towards evening, accompanied with head-
ach, vertigo, naufea, and a fenfe of weight about the
precordia. The pupil is then extremely dilated, but
contracts readily when a ftrong light is prefented to it.
Two of them had the fcurvy in a high degree, one of
them (lightly, and the other feemed entirely free from it.
I am not well acquainted with the nature or cure of this
difeafe, which I believe is called Nyctalopia, by fome
fyftematic writers,

I gavethofe who were affected with it an emetic, which
brought up a great deal of bile, and relieved the fymptoms
both of the head and flomach. This encouraged me to a
repetition of it, which feemed alfo to be attended with
benefit. I likewife applied blifters behind the ears, and
gave bark and elixir of vitriol, with the antifcorbutic
courfe, Jo thofe that required it.

lean

£0OK I. DISEASES OF THE FLEET, 1780. 23

column of which the complement of each
fhip is fet down in order to form calculations
of the comparative prevalence and mortality
of different difeafes at different times. One
of the abftracts is here inferted, (Table I.)
by way of fpecimen, and the proportional
refult of them for fourteen months is fet
down in another table. (Table II.)

Though this laft exhibits a tolerably jufl
view, yet it may be remarked, as one im-
perfection, that there was no diflinclion made
at this time in my returns, between the
killed and thofe who died of difeafe ; fo that
in the month of May, which jftands firft,
the proportion is too high ; for there were
ilxty-four killed, and two hundred wounded,
in the two actions of that month.

I can form no probable conjecture concerning thecaufe
of this difeafe. I have obferved a dilatation of the pupil
in fcorbutic patients, and they complained of a cloud be-
fore their eyes, with imperfecl: vifion, which difappeared
as the fcurvy went off.

WILLIAM TELFORD.

To Dr. Blane,
phyfician to the Fleet.

C4 TABLE

24 DISEASES OF THE FLEET, 1780. PART J.

TABLE

ABSTRACT of RETURNS,

rft

June,

I781.

SHIPS'
NAMES.

c
u

E
0
O

T3
U

ra
0

-0
u

•0

3
0

s
rt

u
J}

« S
£ *
JS 0

U
(A

2 -a

— *j

c 3

c J2

d 8
O

Sandwich -

73*

Barfleur -

767

•33

Gibraltar

650

■8* ' '

Triumph -

650

Centaur r ?

650

Torbay

600

3»

Monarch

600

i '4

Terrible -

600

Alfred

600

RufTel - - -

| 600

i 44

1 »34

Alcide - - -

600

Shrewfbury

600

t 5

Invincible

| 600

! 5°

Refolution

600

107

Ajax

1 55°

Princeffa

q6o

Belliqueux

500

Prince Wi|liam

e;po

■ 25

Panther

420

Triton

200

1 |

Hyena -

200 |

H 1

q '

Cyclops »

200 |

5 1

2 1

Total -

1 1979 i

977 |

696 |

BOOK X. DISEASES OF THE FLEET, I?8o. 2$

The main body of the fleet lay at Barba-
does till the 6th of June, and the men had
recruited extremely by their itay there ; for
vegetables, fruit, and other refrefliments,
can be procured at an eafier rate, and in
much greater plenty, at this ifland, than
any other on the ftation.

The fleet arrived at St. Lucia the next day
after it failed from Barbadoes, and remained
there till the 18th of June. The whole of
this month was fhowery at this ifland, though
jt is not accounted the common rainy feafon,
for more rain falls here than at any of the
other iflands at that time in our potTeffion,
being the moil: mountainous, as well as the
moll woody and uncultivated of them all.
This produced fome increafe of ficknefs, but
very little, when compared to what took
place at the fame time in the army on fhore,
and in the (hips refitting at the Carenage.
There died about this time from fifty to
fifty-five men every week in an army of not
x|uite two thoufand men.

The

26 DISEASES OF THE FLEET, 1780. PART I.

The difference in point of health between
the Carenage (which, as the word implies,
is the place where fhips go to be hove down,
or otherwife repaired) and Gros-Iflet Bay,
where the main body of the fleet lay, affords
a finking proof of the effects of fituation.
The Carenage is a land-locked creek, with a
xnarfh adjacent to it, whereas the other is a
road open to the fine air of the fea, the only
land fheltering it to windward being a
fmall dry ifland, confifting of one hill of
half a league in circumference, and fome
of the cliffs of the main ifland of St.
l_Aicia.

The increafe of flcknefs here was farther
prevented by the men having little labour
to perform on more, nor any haunts to en-
courage intemperance, a vice which the Ad-
miral endeavoured frill more effectually to
prevent, by ordering all the rum-frills in the
neighbourhood to be deftroyed.

It may be proper here to introduce a ge-
neral account of the feafons and temperature
of the Weft Indies, as there will be frequent
2 occafion

BOOK I. DISEASES OF THE FLEET, 1780. 27

occafion hereafter to make allufions to them.
With regard to the heat, though the range
of the temperature is very fmall, in compa*
rifon of what it is in Europe, the variations
follow the fame feafons, for July and Auguft.
are the hotter! months, and December and
January the cooler!:. This we would natu-
rally expect, as our plantations lie all in the
northern hemifphere, between the ioth and
20th degree of N. latitude. The hurricanes
happen in the fame feafon in which the pe-
riodical rains chiefly fall, that is, in the
months of Auguft, September, and October,
which are called the hurricane months, and
this is alfo the moll: unhealthful feafon.
The time of the year which is moil: apt to
be rainy, next to this, is from the middle
of May to the middle or end of June, but
this is not invariable. The loweft I ever ob-
ferved the thermometer was at 690, it ftands
very commonly at 720. at fun-rife in the
cool feafon, riling to 780 or 790 in the mid-
dle of the day. In the hot feafon, the
common range is from 760 to 830. It fel-
dom exceeds this in the made at fea, and
%he greater! height at which I ever obferved

28 DISEASES Of THE FLEET, 1780* PART I.

it in the made on more was 870. This is far
fhort of the extremes of heat which they
experience at certain feafons on the continent
of North America, even very far north. In
Penniylvania and New York, the thermome-
ter, I have been aflured, rifes frequently
above 900. It does fo commonly enough in
the Eaft Indies, but I believe it never was
known to rife fo high in the Weft Indies,
fb that the heat, comparatively fpeaking,
may be called moderate and fleady.

The comparative mortality in June is
fmall, owing to the fleet's having been cleared
of all the bad cafes at Barbadoes before it
failed from thence. Though the proportion
of lick in July is lefs, that of the mortality
is greater, (fee Table II.) which feems to be
owing to this circumftance, that the cafes ta-
ken ill in the wet weather of June, did not
terminate fatally till the fucceeding month.

In the courfe of this fummer, the fleet
was reinforced by feverai mips of the line
from England. The Triumph arrived in
May, without any fick on board ; but a flux

prevailed

BOOK I. DISEASES OP THE FLEET, 1780. 2$

prevailed a few weeks afterwards, with-
out any evident caufe, except the influence
of the climate, and the expofure and
fatigues during the operations of May.
The difeafe, however, ibon fubfided, and
the fhip being kept in excellent order and
difcipline, continued healthy during all the
remaining time in which fhe ferved with us.

In June, the Ruffel, of 74 guns, arrived
from North America, and the Shrewfbury9
a fhip of the fame rate, from England. The
former left England in 1 778, but was obliged
to put back by ftrefs of weather and ficknefs,
and upon arriving afterwards on the coafi of
America, was extremely afflicted both with
fevers and the fcurvy. Thefe were removed
to the hofpital, and this fhip had become free
of all ficknefs before failing for the Wed: In-
dies, except that a few of the men were feized
with fevers, and me remained healthy after
arriving there, not fufTering from any regu-
lar attack of ficknefs, fuch as affe&ed the fhips
in general from Europe. The Shrewfbury
left England healthy, but was foon attacked
2 with

Op DISEASES OF THE FLEET, I780. PART I.

with a fever and flux, which continued to
prevail till the end of the year.

The fever in thefe two mips refembled
rather the low fhip fever of Europe, than
the bilious one peculiar to the climate.
This laft, indeed, feldom or never prevails
to a great degree on board of a fhip, unlefs
it has been caught on the watering duty, or
from fome other expofure to the air of the
land. I have, however, known a few in-
ftances of bilious fevers in men who never
had been on more from the time they left
England ; I have even known men of the
fame defcription attacked with intermittent
fevers, which are fuppofed to depend rtill
more on land air. This is perhaps owing
either to the quantity of water in a great
fhip, part of which is always more or lefs
putrid, or to the frefh-cut wood of the
country taken on board for fuel, the fteam
of all which muft refemble a good deal the
effluvia of marines, which is fuppofed to
give rife to intermittents.

BOOK I. DISEASES OF THE FLEET, 1780. 3I

In the beginning of July, our fleet was
reinforced with the Culloden, Egmont, and
Centaur, all of 74 guns, In the end of the
fame month, we were joined by the Alcide
and Torbay, of the fame rate, and alio di-
rectly from England. The fleet was at this
time at St. Chriflopher's, having arrived
there on the 2 2d of the month, with a large
convoy from England, which had joined it
at St. Lucia, under protection of the Thun-
derer and Berwick, two mips of the line,
which being bound to Jamaica, I do not
reckon as belonging to our fleet.

TABLE

32 DISEASES OF THE FLEET, 1780. FART I.

TABLE II.

Shewing the proportional Sicknefs
tality in relation to the whole
on board, for fourteen Months.

and Mor*

Numbers

MONTHS.

Proportion of Sick and
Wounded on board on
the Firft of the Month.

Proportion of Sick and
Wounded fent to the
Hofpital in the Courfe
of the Month.

Proportion of Deaths
on board in the Courle
of the Month.

■

May, 1780 -

"i8|

2Q|

' 27

June - - -

68J

4l8

July - -- -

i7f

163

Auguft

227

September

188

O&ober - -

November

33l

192

265

December - *

.«

1-1

185

January, 1781

35 '

0 x4

6cl

316

February - -

! 18

413

214

March

J5l

3°

201

April - - -

.- 1

169

May - - -

i 17

188

June - - -

1 40
|

70I

Mean Proportion

.isl

L 93

.227

G H A Pe

t 33 ]

C H A P. II.

Account of the Health of the Fleet from Auguft
1780 till December following. — ———The Fleet di-
vided—The principal Squadron goes to North Ame-
rica— Fluctuation between Fevers and Fluxes— The
Alcide and Torbay the moft fickly Ships —Health
mended by the Climate and Diet in North America—
hurricane in the Weft Indies — Sufferings in confe-
rence of it— Fevers the chief Difeafe.

A HE hurricane months approaching, the
feafon for active operations in the Weft
Indies was now over. The whole force of
the enemy, confiding of thirty-fix French
and Spanim mips of the line, having gone
to St. Domingo in the end of July, ten fail
of the line were detached after them from our
ftation, for the protection of Jamaica. The
Admiral failed for North America in Au-
guft, with eleven fhips of the line, leaving
fix for the protection of the iflands.

There was little alteration in the general
ftate of the fick during the voyage to Ame-

D rica,

34 DISEASES OF THE FLEET, 1780. TART I.

rica, and indeed we found no diminution of
the Weft-India heat, which at this feafon
is at the greatest height, until we came to
the 23° of N. latitude.

The only material alteration in point of
health was in the Alcide and Torbay, which
had arrived from England with a few men
ill of fevers ; but in the courfe of this
voyage they became as unhealthy as any
mips that ever came under my obfervaion.
There was a greater number of rick on board
of them than all the fleet befides, and it in-
creafed to fuch a degree, that upon their ar-
rival at New York, which was in the middle
of September, after a pafTage of three weeks,
near one half of their men were unfit for
duty. In the Alcide it was a fever that raged,,
in the Torbay it was a dyfentery ; and the
unufual degree of ficknefs and mortality
which appears in the Table for the month of
September^ was owing to the very fickly ftate
of thefe two mips.

We mail hereafter ieereafon for fuppofing
rhat fever and dyfentery proceed from the

fame.

[To face page 35.]

TABLE III.

Shewing the Number of Fevers and Fluxes on board on the Firfl of each Month, and the Number fent to the Hofpital in the Courfe of the Month.

SHIPS' NAMES,

AND

Date of their Arrival.

MAY, 1780.

JUNE.

JULY.

AUGUST.

SEPTEMBER.

OCTOBER.

NOVEMBER.

DECEMBER.

JANUARY, 1781.

Fever.

Flux.

Fever.

Flux.

per.

Flux.

Fever.

Flux.

Fever.

Flux.

O pK

Fever.

Flux.

Fever.

Flux.

Fever.

Flux.

Fever.

Flux.

a
O

O
3

0
3

d
O

3
0

*5
0

•a

O
16
60
32

!
■7

T3
O

0
3

G
O

3°

«3

T3
J3
O

2 ^E,

-d

I =

J3
O

g K

,0
O

,5
O

8 a

13
O

u S

5 K

c
O

Sandwich, 1 6th March

•

•9

'4
"7

5 1 *

9 j 0

•3

Tenible, 1 6th March

4> 9

continued cpiteheakhy.

Triumph, 7th May -

O 3 j O

continued healthy.

Rultell, 1 8th June -

continued healthy.

1 1 !

Shrewibury, :6th June

No Returns, being abfent.

•1-

' 1 °

7 0

Alcide, 30th July -

■

0 0

»«

14 | 0

6 1 5

■7

Torbay, 30th July -

—

169

'43

6 I 0

I O

•

M 1 3°

5 °

■

Monarch, 2 2d Nov. -

—

1 » | 0

5 '2

n*-

Alfred, 2 id Nov. -

j 5

1 °

BOOK I. DISEASES OF THE FLEET, 1780. 35

fame caufe ; and as both thefe fhips arrived
from England in a fimilar ftate, with regard
to health, fevers would probably have been
the prevailing difeafe in both ; but a part of
the 87th regiment, then fervipg as marines
in the fleet, was put on board of the Torbay
at St. Chriftopher's, and fome of them be-
ing ill of the dyfentery, gave this turn to
the difeafe which after-wards prevailed on
board. I have formed a Table to (hew the
fluctuating ftate of thefe two difeafes, which
was one of my firft and moil imperfect at-
tempts towards a medical hiftory of the fleet,
in a methodical way. (Table III.)

There was but little ficknefs in the reft
of this fquadron, except in the Terrible,
where the dyfentery prevailed a good deal.
None of the fhips of the line which we
found in the Weft Indies, upon our arrival
there, were now in company, except the
Yarmouth, and this was the moft healthy
of all the fhips that went to North America.

The health of the fleet was very much re-
cruited by its fhort ftay in America, for the
D 2 men

3# DISEASES OP THE FLEET, I'jZo. PART I,

men were fupplied with frefh meat and
fpruee beer, and they enjoyed the two fmeil
months of the year in that temperate climate*
The fquadroii left New York in the middle
of November, and though difperfed by a
violent- ftorm, all the (hips arrived fafe in
the Weft Indies before, the middle of De-
cember.

In October, the fleet had attained fuch a
degree of health, that though the calculation
in the table is made from five of the moft
fickly mips, no death happened in this month
on board of any of them. In November, the
mortality was alfo inconfiderable, though the
fhips left in the Weft Indies are included in
the calculation, which had it been made upon
thofe only that went to North America,
the deaths would have been no more than
one in 71 1 in this month, which is rather lefs
than that of any other month in the table.

The improvement in health, in confe-
quence of the change of climate, was moft
remarkable in the Terrible, which, by the
lime IJie left America, had entirely got rid

U300K I. DISEASES OF THE FLEET, 1780* 3)1

W the violent dyfentery that had prevailed
for fome time onboard. This fudden change
in the health of this fhip was evidently
owing to the great attention of the'Captain to
cleanlinefs and difcipline, and no lefs to the
aflidmty and abilities of the Surgeon. The
Alcide frill continued fickly, though not fo
much fo as the Torbay. The former had
failed on a cruife in October, and having met
with very rough weather, the fick Hit was
thereby increafed. The dyfentery now pre-
vailed in that fhip, as well as fevers, and
thole men chiefly were attacked with fevers
who were ill of the fcurvy, or recovering
from it. This was not very common ; and
there were feveral other remarkable particu-
lars with regard to the fevers in this fhip ; for
her men were not only uncommonly fubject
to this difeafe, both in America and the
Weftlndies, but to all the various forms of
it, the low infections Ihip fever of Europe,
the bilious remitting, and the malignant
yellow fever of hot climates. It would ap-
pear from this, as well as other inftances,
that a fhip may arTurne, as it were, a parti^
cula'r conftitution, or a tendency to fome

P 3 parti-

38 DISEASES OF THE FLEET, 1)80. PART 1.

particular difeafe, for a length of time, and
this depending on fome lurking and adhe-
ring infection, or the manner in which
fhe may have heen victualled, watered, dis-
ciplined, or manned.

The great benefit derived to the health of
the fleet, from the change of climate, as
well as other reafons, juftifled the Admiral
in going to North America ; and there was
the more merit in this meafure, as it was
undertaken without precedent, and without
inftru6tion. Upon our return, we found
there was great good fortune in it, as well
as wifdom ; for there had happened on the
10th of October a more violent hurricane
"than any in the memory of man, and
the ravage it made both by fea and land is
perhaps unparallelled in hiftory. Several of
the fhips of the line were expofed to \t ; but
though they Suffered extremely, and were
in the utmoft danger, none were loft. Two
of them happened to be at Antigua, which
was out of the track of this hurricane, as
it extended only from the 12th to the i^th
degree of N. latitude, fo that the only

tflands

BOOK I. DISEASES OF THE FLEET, I780. J}

iflands that fuffered by it were Barbadoes,
St. Lucia, St. Vincent, and Martinique. —
Four frigates, aud as many {loops of waft,
either foundered or were wrecked, and about
one thoufand feamen perifhed in them. One
of the buildings of the hofpital at Barbadoes
was entirely demolifhed by the impetuosity
-of the fea, which having rifen to a great
height, darned a fhip againft it, and twenty-
three feamen were buried in the ruins*.

The

'* Although this hurricane, in itfelf and its confequen-
<ces, was fo destructive to the lives and health of men, yet
with regard to the inhabitants on fliore, it had a furprifing
and unexpected effect, in mending their health. I wrote
an account of this hurricane to the late Dr. Hunter, who
communicated it to the Royal Society, and the following
pafTage is extracted from it.

" The conferences of this general tumult of nature on
** the health of man, was none of the lead curious of its
'* effects. I made much inquiry on this head, not only
" of the medical gentlemen who had the charge of hofpi-
" pitals, and of the phyficians of the country, but of the
11 inhabitants, and every one had fome cure to relate either
" of themfelves or their neighbours, in a variety of dif-
" eaies. Nor could I find that either thofe who were in
u health, or thofe who were ill of any difeafe whatever,
*' fuffered from it, otherwife than by its mechanical
D 4 " violence ;

4.0 DISEASES OF THE FLEET, 1780. PART I.

The Montague fufFered moil on this occa-
sion, and was alfo molt fubject to ficknefs

and

" violence ; but, on the contrary, that there was a general
" amendment of health. This is a fact, which I could nei-
" ther credit, nor would venture to relate, were it not fup-
" ported by fo many concurring teftimonies. It had a vU
" fible good efFe6l on the acute difeafes of the climate.
" The chronic fluxes, of which there were then fome at the
V. naval hofpital, were cured or much relieved by it, But
- " the difeafes upon which it had moft evident and fen»
" fible effects, were pulmonic confumptions. Some re-
" cent cafes of phthifts, and even the- acute flate of' pleu-
" rify was cured by it, and in the advanced and incurable
" flate of it, the hectic fever wa§ removed, and remark-
" able temporary relief afforded. A delicate lady of my
" acquaintance, who was ill of a pleurify ^t the time, and
" pafled more than ten hours in the open air, fitting ge-
f< nerally feveral inches deep in water, found herfelf free
" of complaint next day, had no return of it, and when
li I faw her a few weeks after, was in much better health
" and looks than ufual. The people obferved that they
" had remarkably keen appetites for fome time after, and
*} the furviving part of them became uncommonly heal-
" thy, fome of both fexes, whom I had left fallow and
" thin a few months before, looking now frefh and plump,

«* It is very difficult to account for this, as well as every
«' thing elfe in the animal ceconomy ; but it was probably
" owing in part, at leaft, to the very great coldnefs an4

" purity

BOOK I. DISEASES OF THE FLEET, 1780. 4%

and mortality, brought on in confequence
of the great fatigue and hardships of the-
men in bringing in and refitting her ; for
the fhip was almofl torn to pieces, both in
the rigging and hul}, and the bedding and
other neceffaries and conveniencies were en-
tirely deflroyed. The fever that prevailed on
board at this time was of the mod: malig-
nant kind known in this climate, and the
worfl cafes arofe in watering, and the other
neceflary duties on more, from which the
men would fometimes return frantic, and
die in a few hours. There was a party of
foldiers on board, and as they were not called
upon to perform any duties on more, they
had but little ficknefs in comparifon of the
failors.

" purity of the air from the upper regions of the atmpiV
" phere. Great agitation of mind fometimes alfoproduces
" a revolution in health ; and we know that the effecl of
" external impreffions in general is very different when
" the mind is vacant, from what it is when occupied and
" interefted by objects, whether of pleafure and fatisfac~Hon,
" or of danger and fuffering."

The

4* EIS-EASES OF THE FLEET, 1780. PARTI*

The other mips having furTered lefs from
the ftorm, were alfo fo{$ fkkly, as it was
not neceffary for them to remain fo long in
the unhealthy Carenage to repair.

The only difeafe that prevailed at this time,
in thefe two mips, was fevers, there being
few or no fluxes, though they had been fo
frequent in the former part of- the year.
Though fevers and fluxes depend on the
fame general caufes, yet when thefe caufes
exift in a higher degree, it would appear that
they are more apt to produce fevers. Thus
the exhalations of the earth from marines
are more apt to produce fevers; and mere ex-
celTes of heat and cold or moifture, are more
apt to produce fluxes; juft as in Europe a ca-
tarrh, which may be considered as a local fe-
brile affection, as well as a dyfentery, will be
excited by expofure to cold or damp, with-
out any fpecific bad quality in the air.

The Ajax and Montague are the only two
ihips of thofe left in the Weft Indies, which
are included in the eftimate of ficknefs and

mortality

JOOK I. DISEASES OF THE FLEET, 1780* 43

mortality in November and December, and
they bear a very great proportion to the
whole ; for out of forty-four that died in
fourteen fhips of the line in November9
twenty died in the Montague, and five in the
Ajax ; and out of forty-three, the whole
number of deaths in December in twenty-
one fhips of the line, ten were of the Mon-
tague^ and eleven of the Ajax.

:CHAP.

'HAP. III.

Account of the Health of the Fleet from January
1781 till July 1 78 1, both Months included. ■ <

Arrival of feven Ships of the Line from England —
Increafe of Sicknefs in conference of a. Defcenton
St. Vincent's • — Long Cruife to windward of Marti-
nique— Great prevalence of Scurvy- — Difference of
Health in different Ships — New Ships not more un-
healthy than others — Why Frigates are more healthy
than Ships of the Line — Remarkable Cure of Scurvy in
two Ships — Effence of Malt —Vegetables moft anti-
fcorbutic in their natural State — Advantage of fupply-
ing Refreftiments on board of Ships in preference to
jHofpitals,

W E are now come to that period in which
pur fleet was reinforced with {even mips of
the line, which arrived at Barbadoes from
England on the 5th of January, 1781, un-
der the command of Lord Hood. This ad-
dition, wfth two which had arrived in No-
vember, made the force upon this jftation
again amount to twenty-one fhips of the
Jine.

Tn«

TABLE IV.

[To face Pige 45.3

Shewing the Number of each Difeafe on board on the Firft of each Month, the Numbers fent to the Hofpital, and Dead, in the Courfe of the Month.

SHIPS'
NAMES.

N. B. Theft marked
», arrived with
6ir S. Hood.

E B R U A R Y, 17S1.

MARCH.

APR

I L.

M A

June.

Fever.

Flux.

Scurvy.

Fever.

Flux.

Scurvy.

Fever.

Flux

icurv

Fever.

Flux

Scurvy.

Fever.

Flux.

Scurvy.

| a
0

J~ --

Sent to the
Hofpital.

Dea,

S S

-6

| K

^1
O

; W

-D
O

4: ~

5 a

A —

5 a

T3
O

13
.£1

5 a

•a

1 ™

-6
O

1 *

-6

E K

.£3

■jj-3

l» P

Sandwich - —

•

1 °

4
35

—

33
iS

* Gibraltar - -

4
4

1 °

°_

—

54
30

•

S
3

—

0
3

—

0
0

■ —

Triumph - -

Centaur - - -

4
S

5°
8

„

5 5
23

—

'3
3

0
4

Torbav - - -

31
1 1

—

4
3

9
36

Monarch - -

.1.

•

-1

Terrible - -

■

.|.

•

3 1 0

Montagu

§ | §

■

Alfred - - -

■>

■

116

■

■■

130

■4

■

Ruflel - - -

■5

0 | 3

—

'3»,

4
0

■

Alcide - - -

■

•

■

1
4

0
0

5
4
2

♦Invincible - -

•

■

•

7
5
3
4

9
5
3

E
0

4
»

54
45

8
I

Rcfolution - -

•

5
4

Shrewfbury - —

1
5

t
3

22 6

Ajax _

■

3°

1 54

* PrincefTa - -

■

•

■ 0,

•

■

•

6
§

Intrepid - - -

■

•

* Belliqueux - -

■

0
0

5
0
0

3
23

5-
47

■

♦Prince William

»'

■9

■47

■

16
9

•

■

; S

• Panther - -

•

■

3 | 0

■

48»

—

Triton - - _

•

■

0 |

-d

—

■

—

Hyena - - -

■

•

■

0 |

0 1

c 1

—
'49

Cyclops - . _

4
97

0
93

■9

4
'74

3 0

0 oj

■7

49 1

~7\

oj o|

Total - -

»4

38 1

02 |,

65 1

9 V

76 |

41 436

IS'

N. B. Where the Spaces are marked thus, §, no Return was made,

&00K I* DISEASES OF THE FLEET, I^Sl* 45

The whole fleet was tolerably healthy
during this month, the feafon being dry and
cool ; there was, however, a fmall increafc
of ficknefs at this time, and it was owing
to a defcent made on St. Vincent's in De-
cember. The foldiers, (of whom there was
flill a regiment on board of the fleet) the
marines, and fome of the feamen, had been
on fhore for one night only 5 hut many of
them having lain on the ground, fome ha-
ving been intoxicated, or having eaten to
excefs of fugar^-cane and fruit, caught fe-
vers and fluxes, which increafed the pro-
portion of difeafes and deaths the following
months, as appears by the Table*

I have exhibited, in another Table, a view
of the ficknefs and mortality of this fleet for
the five fucceeding months. (Table IV.)
This account, as well as moft of thofe that
are to follow, is confined to three difeafes,
that may be called the fea epidemics. Thefe
are fever, flux, and fcurvy.

. The whole fleet met at Barbadoes on the
13th of January, and no fervice was under-
taken

4$ DISEASES OF THE FLEET, 1781. PART I*

taken till the accounts of the Dutch war
arrived on the 30th of that month. In con-
fequence of this intelligence, the greater
part of the mips of war went againfr. St.
Euftatius, which was taken on the 3d of
February.

Ten days after this, a fquadron of feven-
teen mips of the line was fent to cruife to
windward of Martinique, with a view to in-
tercept a French fquadron, which was then
faid to be on its paffage from Europe. The
cruife was there continued for fix weeks, after
which, fmali divifions of the mips were fent
to water and refit by turns at St. Lucia, and
were relieved by the mips left for the pro-
tection of that ifland.

Soon after this, the whole fquadron came
to leeward of Martinique, and though the
former intelligence had proved falfe, the
greater part of our fleet ftill kept the fea, in
order to block up the enemy in Fort Royal
Bay. This they continued to do, till the
29th of April, when a French fleet, of
twenty-two mips of the line, from Europe,

^joined

BOOK lo DISEASES OF THE FLEET, I^Sl, 47

joined by four from Martinique, forced their
way into their own port, pufhing to leeward
our fleet, confining only of eighteen iliips of
the line, fo that the greater part of them did -
not get into port, till they came to an anchor
at Barbadoes on the 23d of May.

It was in this feafon of cruifing, and keep-*
ing the fea, that the fleet contracted fuch a
degree of fcurvy, as had never before been
known in the Weft Indies. This difeafe is
not fo apt to arife in a hot climate as in a
cold one ; and the prevalence of it on this
occafion was owing to the men having been
for a great length of time upon fea victual-
ling; for one part of the fleet had not had a
frefh meal from the time of leaving America,
that is, for fix months ; and that part of it
which came laft from England, had been in.
the fame fituation for {even months ; nor
had any of them been in the way of vege-
table refrefhmenis from the time they left
Barbadoes, in the end of January. But
though no frefh meat or vegetables could"
be procured at St. Lucia or St. Euftatius, yet
the fcurvy did not make fuch progrefs hi

the

48 DISEASES OF THE FLEET, 1781= PART I.

the fhips that lay at anchor there, as in thofe
that were at fea ; and it appears, that the
time in which it prevailed moft was, while
the greateft number of mips was at fea,
that is, in the month of March. It appears,
indeed, by the table, that there was a grea--
ter number ill of this complaint on the ift
of May than on the ift of April ; but it ap-
pears alfo, that more were fent to the hofpi-
tal in March than in April, and very near
half of the May lift mult have been taken
ill in March % The difference of beingJn
port and at fea, confifts chiefly, ift, In
there being plenty of water while in port,
fo that it can be ufed freely, not only to
drink, but to warn the clothes ; and we
know that cleanlinefs tends greatly to ward
off the fcurvy. 2dly, Though no frefh
meat nor vegetables could be procured at
thofe ports, fugar, which may be confidered
as a very antifcorbutic article of diet, could

* In order to afcertain more exactly the degree of
licknefs in each month, a column was afterwards added
to the form of the returns, exprefling the number taken
ill of the feveral difeafes in the courfe of the month.

always

BOOK I. DISEASES OF THE FLEET, 1780. 49

always be procured at a very cheap rate, and
the feamen, when in port, ufed to exchange
their fait provisions for it. 3dly, There is
at iea a difmal uniformity of life, favourable
to indolence and fadnefs, and therefore tend-
ing to haften the progrefs of the fcurvy,
whereas the change of fcene and variety of
objects, when in port, tend to chear the
mind, and thereby to avert this difeafe.

- The fquadron that came from England
under Lord Hood, fufFered, upon the whole,
much lefs from acute difeafes, during the
firfr. months of their fervice in this climate,
than the mips that arrived with Lord Rod-
ney, which was probably owing in part, at
leafl, to the former having arrived at the drieft
and cooleil: feafon of the year* The Barfleur,
however, had a large proportion of all the
three prevailing difeafes, and large mips are in
general more fubjecl: to them than thofe of a
fmaller rate. But of all the mips, the Al-
fred had the greateft proportion of all the
three fea epidemics. The Prince William
fufFered more than any other fhip in the
fleet from the flux, and ? the Princefla,
from the fcurvy. In fome instances, reafons

E can

5D DISEASES OT THE FLEET, 1780. fcAKT IV

can be affigned for the prevalence of parti-
cular difeafes in particular fhips, fuch as ac~
cidental infection, or the manner in which
they have been victualled, manned, or dis-
ciplined, but in many cafes the caufe eludes
our inquiry.

The moll: healthy of the new fquadror*
during - trhis campaign, were the Belliqueux
and Panther; the former was a new fhip,
and came from England with a very irregular
and ill-difciplined crew. Soon after arri-
ving in the climate, (he was- threatened
with a dyfentery, which, though it fpread
a good deal, did not prove fevere nor mor-
tal ; but being left at St. Eu&atius on this
account, while the reft of the fleet were
cruifing, fhe foon became very healthy, and
remained fo. This is the feeond inflance-
of a new fhip being healthy.

The Panther preferved her health by be-
ing on fmall feparate cruifes, and frequently
in port, not being attached to the main fqua-
dron. The Sandwich was the only other
fhip not engaged in the long cruife.

ioOK U DISEASES OF THE FLEET, 1780. §t

Of the mips lately from England, that

were engaged in it, the Gibraltar feems to

have been the leaf* fickly. This Ihip left

England healthy, but having received a draft

of dirty men* when upon the eve of failing*

a fever of the infectious kind broke out on

the paffage, fo that fhe arrived in the Weft

Indies in a fickly ftate. This fever very

foon after difappeared, and it is proved by

this, as well as other fads, that a warm

climate, fo far from tending to generate, or

even to fofter the infe&ion of fever, tends

rather to extinguish it. The Gibraltar had

been put under excellent difcipline by her

former commander, while in the channel

fervice, and this being afterwards kept up,

the men were always clean and regular.

This was the Spanim Admiral's Ihip, taken

by Lord Rodney off Gape St. Vincent's, in

January 1780. She was then called the

Phcenixj and was of a fingular excellence

both in her materials and conftruclion.-—

Whether the cedar* of which a great part

of her timbers confifted, contributed to the

healthinefs, by its balfamic effluvia, 1 will

not pretend to determine.

E 2 The

53 DISEASES OF THE FLEET, I*r8o. PART I.

The Invincible was alio uncommonly heal-
thy during this cruife, which may likewife
be imputed to good difcipline, and to her
having been more than three years in com-
miffion before failing from England, where-
by the men were brought into order, and
accuftomed to each other and to a fea life.
This fhip was almoft fingular in having no
acute difeafes for feveral months after arriving
from. Europe, but at length paid the tribute
fo the climate in May and June, as may be
ieen in the table.

From the account of the three frigates at
the bottom of the lift in the table, it ap-
pears how much more healthy they are than
fhips of the line. The total complements
of the three is exactly equal to that of one
feventy-four-gun fhip ; but their whole fick-
nefs and mortality is lefs than that of any
one (hip of the line of that clafs, although
the Triton was uncommonly iickly for a
ti igate.

There feem to be feveral caufes for the
fuperior degree of health ufually enjoyed

BOOK I. DISEASES OF THE FLEET, I780. $$

by this fmaller clafs of fhips. There is lefs
chance^ of mixtures of men in frigates, as
their complement is fmaller : it is more eafy
for the captain and officers to keep an eye
over a few men than a great number ; for,
in a great fhip, there are generally men,
who concealing themfelves in the mofr re-
tired parts, no one takes cognizance of
them, and they deftroy themfelves, and
infect others, by their lazinefs and filth.
In the next place, there is a greater propor-
tion of volunteers and real feamen in frigates,
and more landmen and prefTed men in mips
of the line, the former being more in requeft,
on account of the greater chance of prize-
money. Laftly, a fmall (hip is more eafily
ventilated, and the mafs of foul air iffuing
from the hold, from the victuals, water, and
other ftores, as well as the effluvia exhaling
from the men's bodies, is lefs than in a
large fhip.

Many other and more minute remarks

might be made on different mips in this fea-

fon of hard fervice ; but to do this would

be fedious, and the inflection of the tables

E 3 may

54 DISEASES OF THE FLEET, IfSo. PART ?^

may fuggefr. obfervatjons to the reader.
There is a ftriking and inftru&iye fact,
however, with regard to two mips, which
J cannot he}p mentioning. The Alcide
and Invincible, both of feventy-four guns.
In working to windward, after the action,
with the French fjeet, on the 29th of April,
anchored at Montferrat on the nth of May,
in order to water. They remained there
only part of two days, and they procured
no refrefhment, except a few bufhels of
limes. The fcurvy was then at a great
height in both (hips ; but between this
time and the 23d of May, when they came
to an anchor at Barbadoes, Hxty men were
difcharged, as fit for duty, from the lick lif^
of the Invincible, and a hundred and four-
teen from that of the Alcide. Thefe were
the only two fhips that had the advantage
of the limes, and during thefe twelve days
the fcurvy continued to increafe in all the
other fhips. Dr. Lind is the firfr. author
who gives a decided preference to lemons,
limes, and oranges, over every other anti-
fcorbutic ; and the above-mentioned fa£t
proves as demonftrably aspoffiblethe infinite
advantage of this fort of acid in fcurvy.

The

fiOOKl. DISEASES OF THE FLEET, 1780. 'SS

The fleet was fupplied with eflence of
malt during all this campaign, and though
it was, no douht, of fervice, it was far
from having that powerful and manifeft, ef-
fect that the acid fruits had, and certainly
-did by no means prevent the fcurvy in all
cafes. I have ftrong teftimonies, however,
of its beneficial effects, from the furgeons of
feveralofthe fhips, particularly the Gibral-
tar, Centaur, Torbay, and Alcide, in all of
which it was found. either to cure the fcurvy,
in its .firfr. beginning,. or to retard its progrefs,
or to mend the appearance of fcorbutic ulcers^,
and difpofe them to heah

I had conceived that molaffes, being a ve«
getable fweet, muft have been a very powers
ful antifcorbutic ; but the greatefl part of
the laft reinforcement of feven mips, came
from England furnifhed with this as an ar-
ticle of victualling, as a iubftitute for a cer-
tain proportion of oatmeal, which was with-
held agreeably to.a late very judicious order
of the Admiralty. But though I am per-
fuaded that this mitigated the difeafe, it was
very far from preventing it, and the Prin-
£efla in particular, which fuffered moll: from

E 4 the

56 DISEASES OF THE FLEET, 1780. FAK.T t,

the fcurvy, was well fupplied with this
article.

There is reafon to think, that it is not in
the vegetable fweet alone that the antifcor-
butic principle refides, but in this in con-
junction with the natural mucilage, fuch as.
exifts in the malt. I fufpecl: likewife that
the change which the effence undergoes in
its preparation, tends alfo to rob it of fome
of its original virtue. But the melaffes are
ftill farther altered by being deprived of the
natural mucilage, by means of quick-lime,
with which all fugar is clarified in the boi-
lers. Dr. Hendy, ofBarbadoes, to whom I
have been obliged for feveral remarks, in-
formed me, that the liquor, before it under-
goes this operation, has been found by him
to produce the moft falutary effects in the
fcurvy ; but as this cannot be had at fea, we
had no opportunity of comparing it with
other antifcorbuties. It is certain alfo, that
the medical effects of the native fweet juices
are, in other refpecls, very different from
what they are in their refined ftate ; for
manna, wort, and the native juice of the

fugar-

BOOK t. DISEASES OF THE FLEET, I}8o. 57

fugar-cane, are purgative, whereas fugar it*
felf is not at all fo. This affords a preemp-
tion, that they may be alfo different in their
antifcorbutic quality, and there is reafon lo
think, from experience, that the more natu-
ral the ftate in which any vegetable is, the
greater is its antiscorbutic quality. Vege-
tables, in the form of fallads, are more
powerful, than when prepared by fire;
and I know, for certain, that the rob of
lemons and oranges is not to be compared
to the frefh fruit. Raw potatoes have
been ufed with advantage in the fleet,
particularly by Mr. Smith, of the Triton,
who made the fcorbutic men eat them, fliced
with vinegar, with great benefit. This ac-
cords alfo with what Dr. Mertans, of Vienna.,
has lately communicated to the Royal So-
ciety of London.

When the fleet arrived at Barbadoes, on
the 23d of May, I found that the number of
fick on board amounted to fixteen hundred,
and that there was not accommodation for
more than two hundred at the hofpital. As
there was hardly any complaint but fcurvy,

the

&§. D-iSEASES OF THE FLEET, 1780. PART I,

the Admiral, at my reprefentation, iffued an
order for ferving the fick on board of their
own mips with fruit and other vegetables and
refreshments, fuch as milk and foft bread.
This courfe of diet commenced in the begin-
ning of June ; and as the greater part of the
fleet was near four weeks thereafter in port,
they enjoyed the advantages of it during
that tkne, and the very great diminution of
^cknefs and mortality, which appears 'by
jfhe tables, in that month, fufficienily evinces
the benefit derived from it. In lefs than
four weeks, the fleet, from being very fickly,
jpecame extremely healthy.

It was remarked, that the men recovered
fairer on board than on more, and it would
appear that land air, merely as fuch, has no
thare in the cure of the fcurvy, and that the
benefit arifes from the concomitant diet,
cleanlinefs, and recreation. The expedient of
curing men on board of their mips, was
here fuggefted by neceffity, but it fucceeded
fo well, that I adopted it afterwards, in pre-
ference to hofpitals, which are ufeful reliefs
to a fleet, where there are contagious acute dis-
orders ;

gOOK I, DISEASES OP THE FLEET, 1780. £0

orders, but with regard to fcurvy, I am,
convinced, that on foreign flations, at leaft
where the accommodations of the lick are
more indifferent than in England, many ad-?
vantages would arife from fupplying men
with refreshments on board of tjieir own mips.
It appears, that only four men died of this
difeafe in the whole fleet in the month of
June, though there were fo many ill of it ;
and it appears by the books of hofpitals, that
fcorbutic men die there in a much greater
proportion, which is owing to other dif-
eafes, particularly the flux, which they
catch by infecYion, or bring on by intem-
perance. It is farther \n favour of this
fcheme, that great numbers of thofe fent
on fhore are loft, by defertion. It is alfo
a great faving to Government, the expence
not being a fourth part of what it would
coll at an hofpital.

The fleet left Barhadoes on the 10th and
1 2th of July, and continued healthy till the
greater part of it failed for North America $a
the beginning of Auguft.

JP ART

L 6o 3

PART L

BOOK II.

Continuation of the Medical History of
the Fleet, from Auguft 1 781, till the
Conclnfion of the War in April 1783.

C HAP. I.

Some Account of the Interval between the Campaign of
of 1 78 1 and the junction of the Reinforcement from
England, in April 1782.-— — The main Body of the
Fleet goes to North America — Lord Rodney goes to
England, and returns to the Weft Indies with twelve
Ships of the Line — Health of the Fleet in England
i-^Sicknefs moft prevalent in the beginning of a War
— A natural Tendency to recovery in Ships and In-
dividuals-— Advantages of this Squadron in point of
Victualling,

W HEN the main body of the fleet went
to America in Auguft, Lord Rodney went to
England for the recovery of his health.—

Wifhing

BOOK ii. JplSEASES OF THE 3TLEET, I^So. 6l

Wifhing to lay before the public boards fe-
veral reforms that fuggefted themfelves to
me, in the courfe of the late fervice, I ac-
companied the Admiral, purpoiing to return
when the feafon for hoitile operations fhould
have brought back the fleet from the coaii
of America.

Soon after arriving in England, I prefented
a memorial* to the Board of Admiralty,
proposing fuch means for the prefer vation of
the health of the fleet, as had occurred to
me during my part fervice.

The Board of Admiralty confidered this
memorial with all the attention that could
be expected in the general hurry of fervice,
infeparable from a great and extenfive war,
and I am happy in being able to fay, that in
confequence of my application, moit of the
particulars recommended have fi nee been fo
far carried into effect, as to produce a practi-
cal conviction of their utility.

* See Appendix to Part II.

Lord

62 DISEASES OF THE FLEET, I7S1. ^ASLT ft

Lord Rodney having recovered his health,
hurried out to his flation with all the force
that could then be equipped, as the enemy
were expected at the Caribbee Iilands, with a
fuperior force, after their fucceffes againfl
us in the autumn campaign in America.

t had again the honoiir to accompany the
Admiral. He firft failed from Portfrriouth
with fix mips of the line, on the 14th of
December, but having been forced into Ply-
mouth, by contrary winds, was there de«
tained till the 14th of January, 1 782. Du^
ring this time, more fhips were got ready,
and fix were added to the fquadron ; for the
public anxiety at that time called forth
every exertion to ftrengthen this reinforce-
ment, upon which the fate of the whole
Weft Indies was fuppofed to depend*

This fleet cleared the Channel in the midft
of a ftorm, and with the wind at the fame
time fo fcanty, that we barely weathered
Ufhant ; but Lord Rodney's perfeverance
and refolution, ftimulated by the exigency
of the occafion, banifhed all heiitation and

timidity e

BOOK II. DISEASES OF THE FLEET, I^Sl. 63

timidity. The rough weather, and contrary
winds, continued through the variable lati-
tudes ; but having met with frefh blowing
trade winds, common at that feafon, we
had the good fortune to get fafe to Barba-
does, with the whole fquadron, on the 19th
of February.

All the twelve £hips * of this reinforce*
ment had been more or lefs at fea iince their
having been commiffioned, except the Anfonj
which was an entirely new fhip, and the
Fame and Yarmouth, which had j oft under-
gone a thorough repair, and had been for a
few weeks at fea in the Channel, before they
were ordered on this expedition.

; The only fhip that was iickly when we
left England, was the Fame, on board of
which fome preffed men, with the infection
about them, had been received from the
Conqueftadore guardfhip, and the fever

* They were the Formidable and Namur, of 90 guns;
the Arrogant, Conqueror, Marlborough, Hercules, and
Fame, of 74 guns ; the Yarmouth, Repulfe,, Prothee,
Ahfon, and Nonfuchj of 64 guns,

which

64 DISEASES OF THE FLEET, 1780. PART X.

which broke out in Plymouth Sound, where
I was firft fent for to vifit that fhip, was pro-
bably owing to the infection which thefe
men brought with them, The other mips
were upon the whole, healthy ; for it appeared
by the weekly accounts delivered to the
Admiral, that the mortality, including even
that of the Fame, for the four weeks before
we failed, had been only one in 1300, and
that there had been about one in 29 on the
fick lift.

An opportunity offered on this occafion of
comparing the health of mips of war in
England with that in the Weft Indies. The
health of the fleet in general at home, was
at this time about the proportion above men-
tioned ; but it is to be remarked, that it
was healthier then, than in the former part
of the war.

Plymouth hofpital, which is calculated
for twelve hundred men, was not half full,
and there Were not at this time more than
fix hundred men at that of Haflar, which is
calculated to contain two thoufand ; but the

latter

BOOK lie DISEASES OF THE FLEET3 178X0 65

latter was generally full during the flrfl two
or three years of the war, from the great
fleets that put into Portfmouth, At one
time, part of the lick were even obliged to
be accommodated with tents in the neigh-
bourhood of the hofpital, for want of room.
But towards the end of the year 1781, the
infectious fever, which conftitutes a great part
of the licknefs in the European feas? was al-
moft extirpated, and in a cruife of five weeks
in the north part of the Bay of Bifcay, un-
der Admiral Darby, in September and Odto-
ber of this year, only fix men were buried in
that time in twenty-eight mips of the line.

This was chiefly owing, as I apprehend^
to the length of time which the wgr had con-
tinued;, in confequence of which the men of
the refpective mips5 companies had been ufed
to each other, and accuftomed to the mode
of life peculiar to a man of war9 regulating
themfelves according to certain rules of good
order and cleanlinefs. The caufes of the
fever above mentioned, as fhall be more
fully illuitrated hereafter, are chiefly connect-

with the circumflances occurring in the be*
F . ginnin;

66 DISEASES OF THE FLEET, 1781. PART J.

ginning of a war, when men of all defcriptions
are mixed, without proper precautions being,
taken to guard again fl the infection imported
from jails or guardfliips- The flcknefs in the
French fleet wasilill greater in the beginning of
the war than in the Britiih, and this has been
the cafe in all the wars of this century. la
the fleet commanded by the Comte D'Orvil-
liers, in J 779* the iieknefs was fo great, as
to difable many of the mips from fervice,
and great numbers of men were landed at Breft,
with a fever fo malignant, as to infect the in-
habitants of the town and country adjacent.
I believe befides, that the general health pre-
vailing at this time in the fleet in England,,
was in part owing to the four crout and me-
lanes, which were now fupplied more amply
than had ever been done before. The entire
exemption from fcurvy in particular, is to be
imputed to thefe improvements in diet.

There is a tendency in acute" difeafes to
Wear themfelves out, both in individuals that
labour under them, and when the infection
19 introduced into a community. Unlefs-
tfcere was fuch a vis medicatrix9 there would

BOOK II. DISEASES OF THE FLEET, I781. 67

be no end to the fatality of thefe diftempers ;
for the infectious matter would go on multi-
plying itfelfwithoutend, and would neceflarily
deftroy every perfon who might be actually at-
tacked, and would infect every perfon who
might be expofed to it. But nature has fo or-
dered it, that this poifon, after exciting a cer-
tain fet of motions in an animal body, lofes its
effect, and recovery takes place; and thofe who
happen not to be infected at firft, become in
fome meafure callous to its impreffion, by be-
ing habitually expofed to it. There is, there-
fore, a natural pronenefs to recovery, both with
regard to that indifpofition which takes place
among a fet of men living together, and with
regard to a fingle individual who actually la-
bours under the difeafe. Thus the moft pre-
vailing period of ficknefs is when men are
new to their fituation and to each other, and
time of itfelf may prove the means of pre-
vention as well as cure.

This confederation, however, ought not to
fuperfede any part of our attention, with re-
gard to the fcurvy, which does not become
ipontaneoully .extinct like acute difeafes.

F % During

:, .DISEASES 0% THE FLEET, • ifzi, part I,

• During the three firft weeks of this paffage
from England to the Well Indies, there was-
wet and boifterous weather, but it had very
little effect in augmenting ficknefs, and
though it not only fubjedted the men to
fatigue, cold, and damp, but prevented the
s from opening their lower-deck ports
the 2d of February, between the 31 ft
&nd 33d degree of latitude, thereby pro-
ducing clofe air and moifture where the
men fleep, yet there were only feven deaths

ron, from its leaving1

England till this time, four of which wen
in the Fame0

The only fea epidemic that made its ap =
pearance? was the infectious fhip fever,
which, in many cafes, was attended with
pleuritic^ rheumatic, and other inflammatory
fymptoms, owing to the cold and wet, to
which the men were expofed in the variable
latitudes. The warm dry frefli breezes which
we had during the remainder of the paflage,
were probably what prevented any bad con-
fequences from the former hardfhips, for
there died only four men from the above-
2 mentioned

FO0K Il« DISEASES ©F THE FLEET, I?§I. _6g

mentioned date, till we arrived at Barbadoes ;
and it appeared by the Admiral's weekly ac-
count, that the proportion of the fick nei-
ther inereafed nor diminifhed? from the
time we got into the fine weather till our
arrival on the 19th of February

This fquadron left England with feveral
advantages in point .of victualling, which no
mips had before enjoyed* They were. amply
fu'pplied -with.- four crout and melafles ; they
had all more or 1-efs wine, of an excellent
quality ; and the Formidable had an entire
fupply of it, in place of fpirits, of which
none was put on board,, This fhip had hi-
therto, and did for fome months afterwards^
enjoy an extraordinary, perhaps an unparal-
lelled degree of health. What farther con-
tributed to the health of this fhip was,
that me had been long in commiffion, and
moll of the recruits with which the crew had
been completed, were men turned ovei: from
other fhipSo There was alfo extraordinary
medical attention paid, particularly in watch-
ing the beginning of complaints,,

E 3 Upon

70 DISEASES OF THE FLEET, 1781. FART I.

Upon the arrival of the fquadron at Barba-
does, it was found, that, the Britifh and
French fleets having returned from North
America, in the beginning of December,
the campaign had opened with the fiege of
St. Chriftopher's, which had been invefted
by twenty-eight mips of the line, and a
considerable army. Our fleet, under Lord
Hood, having attempted, with great enter-
prife and fkill, but without fuccefs, to re-
lieve it, Lord Rodney made hafte to join
them with the reinforcement he had brought
from England. He remained at anchor at
Barbadoes only one night, and in a few days
came off Antigua, where he was informed of
the furrender of St. Chriftopher's ; and here
he joined the reft of the fleet in their return
to windward, on the 25th of February.

CHAP,

[ 7' 3

C H A P. II.

Account of the Health of the Fleet from the June-
tion of the Squadron from England, till the general

Rendezvous at St. Lucia, in the beginning of April.

The Fleet found on the Station very healthy — Health
of the Ships from the American Station — Health of
the Ships from England compared with that of the
Ships found on the .Station — Small-pox prevalent —
Inftance of the remarkable Efficacy of Lemon Juice in
curing the Scurvy — ■ Additional Reinforcement from
England — Watering Duty dangerous and unhealthy—
The mofl healthy Ships thofe that had been Iongeft in
the Climate — Lift of the Numbers taken ill of each
Complaint in March — Inflammations of the Liver,
not common in the Weft Indies.

X HE fleet which we found in the Weft
Indies, confifted of all the fixteen that went
from thence to America in Augufr. 1781,
(except the Terrible, which had been loft)
together with fix {hips of the line* from the

* Thefe were the Prince George, of go ; the Bedford,
Canada, and Royal Oak, of 74; the America and Prudent,
of 64 guns.

F 4 American

n DISEASES OF THE FLEET8 2781, PART T,

American flatkm, the St. Albans, which ar-
rived from England in November, and the
Rufiel, which had been in the Weft Indies
during all the hurricane months. They
were all extremely healthy, having only
one man in twenty-eight on the lick lift, and
very few had been fent to hofpitals.

This fleet, after arriving from America?
had lain at anchor for three weeks at Barba-
doess where it had the advantage of the ve-
getable refreshments which that ifland affords*
but during three weeks that it lay at anchor
in the face of the enemy at St. Chriflopher's,
the men were excluded from all commu-
nication with the fhore, and had no vege-
table food, except fome yams, with which
they were fupplied from Antigua, in place of
bifcuit, of which there was at this time a
fcarcky* Thefe mips had therefore been in
bo port for fix weeks*, except for a few
days that they lay in the road of Antigua,
refitting, and putting the lick and wounded

300K II, DISEASES OF THE FLEET, 2781* 73

The men had alfo been deprived of their
natural reft, and expofed to the air during all
the time that the fleet was at anchor be-
fore St'. Chriftopher's ; for they had been
twice attacked by the enemy in that iitu-
ation, and were therefore under the necejlity
of keeping the mips conftantly clear for ac=
tion : yetnoincreafe of ficknefs followed* This
might partly be owing to the eagernefs and
alacrity of fpirits naturally excited in fuch a
fituation, and alfo to the fleet not lying under
the lee of any land, and having fprings upon
their cables, fo that they had all the perflation
and ail the purity of air which ihips enjoy
when at fea. The fumigation which mips
undergo in battle, has alfo been thought to
contribute to their healtho

To whatever caufe it was owing, the fleet
we found in the Weft Indies was at this
time healthier than that which hadjuft come
from England, and there was but little dif-
ference in the degree of health of the dif-
ferent mips that compofed it. Of thofe
which left the Well: Indies in Auguft, and
returned in December^ the only one that

could

74 DISEASES OF THE FLEET, 1781. PART I.

could be fkid to have any epidemic difeafe
was the Prince William, which had never
got entirely free from the dyfentery that pre-
vailed in her to fuch a degree laft year. The
difeafe was kept up, by the fhip never ha-
ving been cleared of the men affected with it,
and by the crew in general being ill provided
with (lops*, a circumftance that would
render them more fufceptible of whatever
infection they might be expofed to.

There were alfo fome remains of the fame
difeafe in the Intrepid, the feeds of it having
been more or lefs continued from the fummer
of 1 780, at which time it prevailed to a mofr.
violent degree. The Alfred had a few of all
the fea epidemics, and had been for a long
time before more or lefs in the fame fituation,
from a neglect of cleanlinefs, particularly of
the men's perfons.

The only fhip in which there was any
thing like an epidemic, was the Canada.
This fhip, when at home, had for many
months before me failed been in unremitting

* This is the term for the different articles of feamen's
cloathing, particularly ihirts and trowfers.

fervice,

BOOK II» DISEASES OP THE FLEET, 1781. 75

fervice, and very little in port. On the paf-
fage from England to America, in Augufl
1 78 1, there broke out a fevere dyfentery,
to which the fcorbutic habit of the men,
from being fo long at fea, probably pre-dif-
pofed them. Though it had abated much in
February 1782, it was then by no means
extinct, and continued till April. The
Prince George had been in commiffion all
the war, and was a model of difcipline and
cleanlinefs, and therefore of health. This
continued till the paflage from America, and
upon the flrft cold weather after leaving
New York, a violent dyfentery appeared, of
which fixteen died. This is agreeable to
what Dr. Lind obferves, that the flux may
be brought on by a fudden tranfition, either
from cold to heat, or from heat to cold.
All the men that were ill of this difeafe
having been fent to the hofpital at Barbadoes,
and the ufual attention to cleanlinefs having
been kept up, the difeafe entirely vanimed.

All the other (hips of the American fla-
tion had been more or lefs vifited with fick-
nefs after they left England, except the

Bedford.

JO ^DISEASES OF THE FLEET, lj8le PART I,

Bedford, This was probably owing to this
fhip having been longer in commiffion than
any of the others, that is, for four years,,
and all that time under the fame comman-
der. This lair, circumftance falls to the lot
of few mips ; but is attended with great
benefit ; for the mutual knowledge and at-
tachment of the captain and fhip's company
is naturally productive of regularity and good
difcipline, and therefore of healths

The Royal Oak, Prudent, and America,
which left England with the Bedford,
though they had been afflicted with the
fcurvy and other complaints foon' after ar-
riving in America, had been quite healthy
for fome time before coming to the Weft
Indies, and were fo much fo at this period9
that, though there were a few fores and
flight complaints on . their nek. lifts, there
was not a man confined with illnefs, fo as
properly to be called lick. The Royal Oak,
having been the flag fhip of Admiral Ar=
buthnot, was manned with choice feamen,
which is a circumftance generally conducive
to health ; for thefe being accuftomed to a

300K J4U DISEASES OF "THE FLEETj I?8l«.' 77

lea life9 are more provident^ more handy
and methodical in all that relates to diet;,
cloathingj and cleanlinefs. The fcurvy/-
which inferred her upon flrft. arriving in
America^ was fuccefs fully treated on board
by ferving to thofe who were ill of it a
mefs compofed of foft bread, baked on pur°
pofe? and mixed with -wine and efTence o£
malt.

The Prudentj though now quite healthy^
had been fickly foon after being put into
commiffion in Europe, and upon fir ft ar-
riving in Americao She had been uncom-
monly fickly after being firfr put into com-
miffion when a new (hip, and was fient to
the Baft Indies during the peace0 This re-
markable degree of ficknefs was probably
owing to a particular experiment that was
made in preparing the wood of which (he
was built, The experiment confided in
foaking the timber for a length of time in
a ftrong pickle, ill order to make it lefs
corruptible. The only other fhip on
which this was tried was the Intrepid/
and we have already mentioned that this

was

?8 DISEASES OF THE FLEET, 1 78 1. PART U

was an extremely fickly (hip. The effect
of it upon the wood was to caufe a con-
ftant moifhire and mouldinefs in the orlops
and holds. In the Intrepid, the ficknefs
was never conquered till a practice was fol-
lowed of pumping and bailing her with
great care, and putting a fire into the well
for fix hours every day, by which means
the former dampnefs and mildew were re-
moved and prevented, and the fhip ren-
dered healthy.

The two fquadrons being united, and
confifting of thirty-four fhips of the line,
proceeded to St. Lucia, where they arrived
on the 1 ft of March.

I received monthly returns as formerly,
and the form of them was improved by
adding a column for the numbers taken ill
of the feverai difeafes in the courfe of the
month. The returns of February are not
complete, there being none for the ift, as
we had not then arrived ; but as the re-
turns of the 1 ft of March have relation to
the preceding month, a judgement may be

formed

BOOK XI* DISEASES OF THE FLEET, I781.

formed of the ficknefs and mortality of
February from the following table :

EXTRACT from the RETURNS of
the iffc of March 1782.

DISEASES.

Put on the

Sick Lift

laft Month.

Died laft

Month.

Sent to the

Hofpital
laft Month.

Fevers - - -

553

Fluxes - - -

263

Scurvy - - -

121

Other Complaints

6l8

Total - -

*555

109

This account is abflracted from the returns
of twenty-nine mips of the line, and two*
frigates.

The difeafes and deaths under the head of
ic Other Complaints," is much more nume-
rous in this month than ufual, which is
chiefly owing to the preceding actions with
the enemy, and to the prevalence of the

fmall-

SO DISEASES OF THE FLEET, I'/8x0 PART t,

fmall-pox. Of the deaths under this head,
feventeen were in confequence of wounds,
fix of fmall-pox, one of a mortification in
the moulder3 and one of confumptiom

None of the epidemics affected one part of
the fquadron more than another, except that
the mips lafl from England had a lefs pro-
portion of the flux than the reft i and the
few cafes of this difeafe that were in thefe
fhips, arofe after their arrival in the climate*
The Conqueror and Fame, which were the
two moil fickly ihipsj had no complaints but
fevers.

The fevers had now begun to take on
fome of the characleriitic fjmptoms of the
climate ; the chief of which is a greater
abundance of bile. In the Repulfe9 two
men had the veliow colour of the fkin, which
is fo peculiar to the fevers of this climate.

The crew of the Anfon caught an infec-
tious fever from a guardfhip in England ;
and when the Prothee failed, there was a
fever of the fame kind on board3- but from

*OOK II. DISEASES OF THE FLEET, 178?." 8l

the change of climate, the fymptoms be-
came milder, and the difeafe had difappeared
in both thefe fhips in the courfe of this
month.

The mortification in the moulder, men1
tioned above, was fomewhat lingular. It
happened to a man in the Yarmouth, who*
after being for a week ill of a fever and
flux, was one day, early in the morning*
feized with a pain in the upper part of the
right arm, which immediately begaa to
mortify. He foon after became convulfedj
and died the fame day about two o'clock.

The fmall-pox prevailed more at • this
time in the fleet than I have ever known
it to do either before or fince, and that
both in the fquadron from England and in
that from North America, There were fix
cafes in the Formidable, all of which did
well, though two were of the confluent
kind»

Though there needs, hardly any additional
proof of the extraordinary efficacy of lemon

G juice

%Z DISEASES OP THE FLEET, 1782, FART U

juice in curing the fcurvy, yet it may be of
fervice to imprefs fo ufeful a truth on the
mind by mentioning fuch finking proofs of
it as occurred. The Arrogant fpoke with a
Portuguefe veffel near Madeira, from which
fome of this fruit was procured, and the
only fcorbutic man on board happening to
have fome of the moll: defperate fymptoms,
fuch as putrid gums, contracted hams, the*
calves of the leg hard and livid, and fre-
quent faintings, a fair opportunity offered
for trying its virtues. The man was allow-
ed two of them daily, and was perfectly
well in fixteen days, during all which time
the fliip was at fea, fo that it was impofii-
ble to afcribe the cure to any other caufe.

The fleet remained at St. Lucia from the
id till the 1 8th of March, completing the
water, provifions and ftores, landing the lick
at the hofpital, and alfo watching the mo-
tions of the enemy* who arrived about the
fame time at Martinico from the fiege of St»
Chriftopher's, During this time we were
reinforced with the Duke, of 90 guns, and
the Warrior and Valiant, of 74 guns, from

England.

BOOK II. DISEASES OF THE FLEET, I782. 8$

England. On the 18th the whole fleet,
except the Invincible, which was detached
with a convoy to Jamaica, failed on a cruife
to windward of Martinico in queft. of a
French convoy, expected from Europe ;
which having eluded us, and got into their
own harbour, the whole fleet returned to
St. Lucia on the 30th of March, excepting
the Prudent, which was fent to Barbadoes.

We found at St. Lucia the Magnificent,
of 74, and the Agamemnon, of 64 guns,
which were the laff. reinforcement of this
campaign, making the Britifh fleet, on
this ftation, amount to thirty-nine mips of
the line, a much greater force than was ever
before employed on foreign fervice. They
were all copper bottomed.

The weather continued fine' all this month,
yet there was fome increafe of ficknefs, ow-
ing chiefly to the hardfhip the men under-
went in wooding and watering. In Choc
bay, where the fleet watered, there was at
this time a higher furf than was ever remem-
bered, which made the operation of watering
G 2 (at

84 DISEASES OF THE FLEET, I782. PART &

(at all times noxious in this climate) un-
commonly toilfome and dangerous. It
was, indeed, next to impracticable ; for
many longboats were ftaved on the beach,
by which feveral men had their limbs broken,
and fome loft their lives, by being crufhed
or drowned ; but the neceffity of the fervice
admitted of no relaxation or delay. There
was no increafe of wind to account for this
furf; fo that it was owing either to fomething
in the currents, or to fome fubterraneous
caufe, and there had bsen feU at Barbadoes
and St. Lucia about this time a flight fhock
of an earthquake *,■ to which many imputed

this

* Earthquakes are frequent in the Weft Indies, and per-
haps proceed from a weaker operation of the fame caufe that
originally produced the iilands themfelves, which feem all.
to have been raifed from the fea by fubterraneous fire.
There are evident veftiges of volcanos in them all, except
Barbadoes; but there are other unequivocal marks of this
ifland having been raifed from the bottom of the fea, for
it is entirely formed of coral, and other marine pro-
ductions, of which the ftrata are broken, and the parts
fefc at angles to each other, as might be expected from
fuch a caufe. - There is, perhaps, at all times in the
caverns of the earth, elaflic vapour, ftruggling to vent

itfelf.

BOOK II. DISEASES OF THE FLEET, 1)82. 85

this extraordinary furf. In other refpe&s,
there were fewer caufes of ficknefs, than
ufually occur to a fleet in port in this part
of the world, for the air of the road is re-
markably pure, and there were fewer temp-
tations and opportunities of intemperance
than at the other iflands.

The monthly returns of the furgeons were
very full and complete ; but as it would be
tedious to infert at length thofe of every parti-
cular fhip, and as the number of mips fluctu-
ated in different months, I mail do no more
hereafter than fet down the general refults
from calculation, fo as to fhew the propor-

itfelf, and when near the furface, it may fometimes over-
come the incumbent maffes of matter, and produce cer-
tain convulfions of nature. In the account of the hurri-
cane, which I wrote to Dr, Hunter, I gave reafons for
believing, from the teftimony of the inhabitants, that
hurricanes are attended with earthquakes, and if a con-
fiture might be advanced, concerning the caufe of this,
it might be faid, that as the atmofphere is lighter at that
time, by feveral inches of the barometer, the elaftic va-
lours, confined by the weight of the incumbent earth and
atmofphere, being lefs compreffed, may exert fome fec-
lible effects,

G 3 tional

DISEASES OF THE FLEET, 1782. PART j,

tional prevalence of difeafe and mortality in
each month.

TABLE, fhewing the proportional Sick:
nefs and Mortality in March.

DISEASES.

Proportion of thofe
tak6n ill in the
courfe of this
Month.

Proportion of thofe
who dic-d in rela-
tion to the Num-
bers of the Sick.

Fevers -
Fluxes - - -
Scurvy - -
Other Complaints

35
126

33
I 9

■ 64

71
0

108

! 76

General Proportion

The firfl column is formed by dividing the
whole number on board by the number taken
ill. The fecond column is formed by firfl

adding

*OOK I J. DISEASES OF THE FLEET, 1782. 87

adding the number ill on board on the ift
of the month, to the number taken ill during
the month, fubtracting from this fum the
number fent to the hofpital, and dividing the
remainder by the number of deaths.

The number on the lick lift of 28 mips of
the line, and two frigates, on the ill: of this
month, was 845. The number put on the
lifts in the courfe of the month, was 1884,
and the number fent to the hofpital in the
fame time was 373, and there died on board
thirty-one.

The total mortality this month, in relation

to the whole number of men on board, wras
one in 607.

It almoft, always happens, that mips of
war are more or lefs mort of complement,
and allowance is made for this in all the
calculations ; for having had an opportu-
nity of infpeeting the weekly -accounts deli-
vered to the Admiral, it was always in my
power to be informed how many there were
mort of the legal complement of hiqu in
each fhip.

, G 4 It

88 DISEASES OF THE FLEET, 1)82. PART %9

It appears, from comparing the tables, of
this month with thofe of the preceding, that
there had been a great increafe of fevers and
fluxes, particularly of the latter. The fevers
prevailed chiefly in the fhips lately from
England, efpecially the Fame and Conque-
ror. In the Duke, there were a great num-
ber ill of fevers, but this fhip not having ar-
rived from England till after the ift of the
month, is not included in the calculation.
The fluxes were mofc prevalent in jfcfoe mips
we found on the ftation, particularly the
Canada, Refolution, and Nymph frigate. — ?
The fcurvy had increaied very little, but
prevailed mofl in the fhips we found here.
The only fhips of the new fquadron that had
this difeafe to a coniiderable degree, were the
Conqueror and ISFonfuch. The former had
indeed a good many ill of it, but the return
having been made in an imperfecl manner,
this fhip is not included in the calculation.

But the mips that were by far the mofl

healthy, were thofe that had been the longefl

from England, the Aj.ax, RufTel, Montague,

, Royal Oak, and Prudent. There had been

formerly

BOOK II, DISEASES OF THE FLEET, I782. 89

formerly a great mortality in all thefe mips,
and it would appear that this uncommon
degree of health was owing, in fome meafure
at leaft, to this circumftance, that the moft
weakly had been fwept off by the different
diflempers to which they were expofed, fo
that only the more hardy and robuft had
furvived,

Under the head of Ct Other Complaints,**
a much fmaller number were put on the lift,
and ftill fewer died in this than the prece*
ding month. This difference is owing to
£he number that died of wounds laid month.

There died on board, in the courfe of
this mouth, thirteen of fevers, feven of
fluxes, and feven of other complaints, of
whom five died of fmall-pox, one of afmma,
and one of wounds he received at St. Chriflo-
pher?s.

In order to mow more fully and minutely
what are the complaints incident to fleets in
this climate, I (hall fet down a lift of the

- . numbers

<§Q ■ DISEASES OF THE FLEET, 1782. PART I,

numbers taken ill of the different difeafes and
accidents during this month,, extracted from
the returns of 28 mips of the linea and two
frigates.

Fevers -

806

Dropfy -

Fluxes -

463

Ophthalmia « -

Scurvy -

130

Leproiy

Ulcers

129

Fiflula in ano

Small-pox

Hernia humoralis

Pectoral com-)
• plaints - J

Abfcefs
Fractures *

Venereal com-)
. plaints - J

Various flight 1
accidents, as i

16 3

Colds -

3°

bruifes, cuts, j

Rheumatifm -

fcalds, &c. J

Angina

Gravel *■.••.*•

Total i\

IS4.

The number of ulcers bears here a fmaller
proportion to the whole, than it does in ge-
neral to the fum total of the fick liil j for being
the moil tedious of all complaints, they con-
fequently accumulate more than any other.
Thus, many of the cafes now fet down as

flight

BOOK II. DISEASES OF THE FLEET, I7S2. 9I

flight accidents, will, in the enfuing month,
be in the ftate of obftinate ulcers.

Moft of the difeafes of one hot climate
refemble thofe of another, fo far as I know \
but there is one difcafe which we hear of as
being extremely prevalent all over the Eafl
Indies, which is hardly ever met with in the
tropical regions of the Weft. This is the
inflammation of the liver, of which I remem-
ber to have feen only one well-marked cafe,
and it was that of a gentleman who had been
in the Eaft Indies, and had been fubject to it
there. Nor do I recoiled more than one, or
at moft two, cafes of this fort, out of feveral
thoufand cafes of various difeafes, that
were reported to me. This is either ow-
ing to the greater heat and drynefs of the
air in the Eaft Indies, or fome other peculi-
arity with which we are not acquainted.

Every other inflammatory complaint exifts
more or lefs, though they are much rarer
than in cold and temperate climates. The
phthifis pulmonalis is not fo common as in
cold climates, but proves fooner fatal to moil:

conftitu-

1)2 DISEASES Or THE FLEET, t)%2» PAXT I.

constitutions. There are certain pulmonic
complaints, particularly thofeof the afthmatic
kind, to which the climate of the Weft In-
dies is remarkably favourable, but thofe in
which there is ulceration feem to be hurried
fafler to a fatal termination. The climate,
from the thirtieth to the fortieth degree of
latitude, feems to be beil fuited to confump-
tive complaints. The rheumatifms that
occur in this climate are moftly of the crn-o-
nic kind*

CHAP»

[ 93 ]

C HA P. III.

State of Health of the Fleet in April 1782. — —Battles
on the 9th and 12th — The fleet very healthy —-from
the Quality of Provifions — from the Effects of Vic-
tory — Advantages of clofe A6lion — What Difeafes
moll prevalent — Extraordinary Degree of Health la
the Formidable.

Jl HIS month being interesting, on account
of the memorable engagements that happened
In it, the remarks fhall, for this reafon,.be
fomewhat more full and particular,

' Two fhips of the line having been fent to
protecl a convoy to Jamaica, and one having
been fent to protect another convoy to Barba-
does, there remained thirty-fix at St. Lucia
in the beginning of this month. By the
end of the firft week their damages were
repaired, their water and provifions complete,
and the fick in a great meafure recovered.

94 DISEASES OF THE FLEET, 1782. PART 1.

An equal force of the enemy lay over
againft us at Martinico, the two powers of
Britain and France being to make this diftant
quarter of the world the theatre for trying
their ftrength, and deciding the fovereignty
of the feas. In the view of this great event,'
our commander forwarded the neceffary du-
ties of the fleet with fuch zeal and diligence,
and watched the motions of the enemy with
fuch vigilance, that he overtook their grand
fquadron a few hours after they left their
own port, and engaged them two feveral
days, with a fuccefs glorious and complete.

Nothing had been wantingto equip this fleet
for the great and decifive exertion it was to
make. Every fhip, except two, might be
faid to be healthy, mofl of them were com-
plete in men, well appointed with officers,
and well found in ftores and provisions. -—
Conformable to this was the eagernefs, the
confidence, and resolution, which led them,
to fuccefs and victory.

After this . battle, the whole fleet, with
the prizes, bore away for Jamaica, where

part

[To face Page 9S0

TABLE V.
ABSTRACT of the RETURNS for APRIL, 17S2.

SHITS'
NAME S.

F.E V E R.

FLUX.

SCURVY.

WOUNDS.

; li

J jj

0 "

i>£

! =

•Formidable -

6
8

5
30

-7-

-7

•

Barfleur - - -
Prince Grorgc -

-~r

~f-

— 7

—7-

-7-

• Duke - - -

7«

« Namur - -

Roj.il OA - -

-^-

-';

--7-

-7-

•

Alfred - - -
Montagu

Jl-

•

■

3°

■

•

-7-

•■s

- -
• -

5
5

— o-

■

— 7

-7-

-f-

•

■ W11 rior - -

•

-7-

Centaur - - -

«■

•

■5

•

< M gnificent -
Bedford - - -
Ajax - - -

— °-~

■

•

<>'

■

—7

•

3°

Canada - - -

•

■

>•

Rciolution - -

■ 9

= s

■

= 7

» Herculei - -

•

„

•

— 7

Ruffel - - -

-7-

« Fame - - -

■

Torbay - - -
PrincelTa - - -

—

-—

-7-

•

■>

• Con ,ueror • -

3°

„

—7

•3

— 7

-
« Yarmouth - r-

•

— ~

...

— "—

-|-

— 7

•

- 6

-f"

— 7

Belliqueu* - -

Il8

Prince William -

-A-

— -

•

-—

» Rcpulfc - -

"7"

•

T-7

•

-7-

. -

■

America . - -

■4

•Anion - - -
« Nrjnfuch - -

-f"

— "-

■

•

-7-

■ a

-7-

—7

— ~

77-

-7-

AlciJe - - -
Ramillki - -

■

Nymph - - -

■

--7

Flora - - _

•

■

•

103

ao8

Total - -

3'*

743

■5

■93

516

N. B. The Sl.ipl marked thus, », came from England in February and March, I78a.
All the Ship, named In ihe Table were in the Engagement! in April, eacept the Ramiliet and the two Fri
In the Spacei, marked thui, §, no Return was made.

BOOK II. DISEASES OF THE FLEET, I7S2. 0$

part of it arrived on the laft days of April,
but the greater part of it kept the fea till
after the middle of May.

As this month is more than ufually inte-
refring, the tables are given at full length,
and a column is added for the wounded.

The fum total of the numbers of the men
on board of the thirty-fix mips that compofed
the line of battle on the 12th of April, was
21,608, and the mortality in proportion
to this, during the month, exclufive of
wounds, was one in 862.

There was lefs ficknefs, and lefs death,
from difeafe in this month, than any of the
former twenty-three months, in which I kept
records of the fleet, and lefs than in any
fubfequent month, till the fleet got to the
coaft of America.

To account for this, it is to be obferved,
that the men had not been expofed to the
noxious air of the more in watering, as in
the preceding month : they had received

from

96 DISEASES OF THE FLEETj 1782. PARTI.

from England a frem fupply of provifions,
among which was four krout, melaffes, and
effence of malt, all in addition to the ordi-
nary articles of victualling : many of the
ihips were fupplied with wine, in place of
rum, and as the weather was all along dry
and fine, the men fuffered the lefs from the
expofure and want of fleep, which are the
neceffary confequences of keeping the ihips
clear for battle for feveral days and nights
together.

Might not this extraordinary degree of
health have alfo been owing, in part, to the
effects of fuccefs upon the fpirits of the men?
It is related*, that when the fleet under Ad-
miral Matthews was off Toulon, in daily
expectation for fome time of engaging the
combined fleet of France and Spain, there
was a general flop put to the progrefs of dif-
eafe, particularly of the fcurvy, from the in-
fluence of that generous flow of fpirits, with
which the profpecl: of battle infpires Britifh
feamen. But if the mere expectation and

* Dr. Lind, on the authority of Mr. Ives, Surgeon to
Admiral Matthews,

ardour

500K II. DISEASES OF THE FLEET, 1782.. 97

ardour of a battle, without any happy event,
could have fuch a fenfible effect, what muft
have been the effect of the exultation of vic-
tory, a victory in which the naval glory of
our country was revived and retrieved, after
a feries of misfortunes and difgraces, which
had well nigh extinguifhed the national pride
in every department of fervice. The plain
and honeft, though unthinking feaman, is
not lefs affected by this than the more en-
lightened lover of his country. Even the
invalids at the hofpital demonftrated their
joy, upon hearing of this victory, by hoift-
ing mreds of coloured cloth on their crutches.

It would appear, that there is fomething
in fituations of exertion and danger, which
infufes a fort of preternatural vigour. When
the mind is interefted and agitated by active
and generous affections, the body forgets its
wants and feelings, and is capable of a de-
gree of labour and exertion, which it could
not undergo in cold blood. The quantity
of mufcular action employed in fighting at a
great gun for a few hours, is perhaps more
than what is commonly employed in a week

H in

98 DISEASES OF THE FLEET, tjSz* YA.RT ?«•

in the ordinary courfe of life, and though
performed in the midft. of heat and fmoker
and generally with the want of food and
drink, yet the powers of nature are not ex-
haufted nor overftrained ; and the future
health of thofe who furvive unhurt by exter-
nal violence, is fo far from being injured,
that it is fometimes mended by this violent
•but falutary agitation.

The lofs in action, and the number of mor-
tal wounds, were not fo great as might have
been expected in a battle continued for a whole
day. This advantage was owing to the fuperi-
ority of our fire, as well as to the clofenefs of
the fight, of which the Commander in Chief
fet the illuflrious example, by penetrating
the enemy's line with his own fhip ; and this
bold and lingular effort firft decided the event
of the day. When mips in action are oppofed
to each other at a fmalldiftanee, the velocity of
cannon balls is fo great, that in penetrating a
fhip's fide, few or no fplinters are torn off; and
by thefe more men are commonly killed and
wounded, than by the ballitfelf. For the fame
reafon, a clofe mot does lefs damage alfo to

the

50OKIX* DISEASES OJF THE FLEET, I782. 99

the fKip itfelf than a diflant one ; for a
quick-flying ball makes an aperture lefs than
its own diameter* whereas a fpent one pro*
duces innumerable deadly fplinters, at the
fame time fhivering the object it ftrikes, and
making wide and exten£ve rents in it. The
proportion of the wounded tothekilled, is alfb
greater in diftant than in clofe fight, on ac-
count of the greater number of fmall fplin-
ters ; and we have an experimental proof
of this, in comparing the adYion in Fort-
Royal Bay in April 1781, with that near
Dominica in April 1782. In the former*
the enemy having kept far to windward,
and engaged at a great diftance* the pro-
portion of the wounded to the killed was
conliderably more than four to one*; whereas
in the latter, when the greater part of the
battle was clofe, the proportion of the
wounded to the killed was little more than
three to onef*

Though

* London Gazette*

f This is well illuflrated by the manner in which
Captain Nott, of the Centaur, was killed in Fort-Royal

H % Bay*

100 DISEASES OF THE FLEET, 1 782. PART F*

Though it is a remark not belonging to a
medical work, yet it may be obferved,that the
greateft advantage that arofe to us from clofe
action was, that the fire of the enemy was
thereby filenced; for the advantages would be
equal on both fides, on the fuppofition, thafc
the French, in fuch a fituation,. were to keep
the deck, and ftand to their guns equally
well with the Britifh feamen.

It appears, by infpecYing. theTable, that the
mips in which the fevers chiefly prevailed this
month, were thofe that had come laft from
England, and that thofe in which the fluxes
prevailed mofr. were chiefly of the fquadron
we found on the Ration, namely, the Cana-
da, Refolution, and Prince William. Thelat-
ter, however, recovered greatly. in the courfe

Bay. This brave man having carried his fhip nearer
the enemy than the reft of the line, but neverthelefs at
a great diflance, had his fignal made to keep the line,
and having gone into his cabin, as is faid, to examine
the import of the fignal, a cannon ball ftruck him in the
groin, and it was fo far fpent, that it ftuck in his body.
It tore away a whole plank of the fliip's fide, the fplin-
ters of which killed a young gentleman, the only perfon
near him.

S500K II. DISEASES OF THE FLEET, 1782. IOI

of this month. Some of the mips that arri-
ved laft fromEngland, namely, the Arrogant,
Prothee, and Anfon, were alfo confiderably
afHi&ed with fluxes, but they were of an ex-
tremely mild kind, and the fmall number of
deaths from this difeafe in comparifon with
thofe from fevers, is a proof of a former
obfervation, that this is the fafefl form
in which an acute difeafe can mew itfelf.
This fmall degree of mortality was alfo owing
to the judicious method of treating it which
was in general praclifed throughout the fleet ;
and it is but juftice to the medical gentlemen
to fay, that they fhewed on this, as well as
every other occafion, great fkill and attention
in the treatment of the fick and wounded.

The fum total of fevers and fluxes that
have been put on the lift this month, is much
the fame as that of the preceding month ;
but the proportion of fluxes in April is much
greater.

The proportion of fcurvy is fomewhat in-
creafed ; which is not to be wondered at,
when it is confidered, that though the fleet
had not been fo long at fea as is neceflary to

H 3 produce

102 DISEASES Or THE FLEET, I782. PART I,

produce it, efpecially in this climate, yet the
men having had no refrefhments when lafl in
port, may be confidered as having been all
that time at fea.

The fuperior degree of health in this
month will appear in a frill ftronger light,
if we caft our eye on the column expre£?
fing the number fent to the hofpital, the
proportion of which is comparatively very
fmall.

The mips that had been the longefl: from
England, were ftill among the moll: healthy,
But of all the fleet, none was fo free from
ficknefs and mortality as the Formidable.
No man belonging to this fhip died of difeafe
for the firfl four months after failing from
Plymouth, though there were at times
-900 men on board, and never lefs than the
eftablifhed complement, which is 750 ; and
fo few were taken lick in that time, that
only thirteen were fent to hofpitals, and
their complaints were fmall-pox and ulcers.

Thi£

'SpOK II. DJSE4-SES .OF TliE FLEET, 1782. IO3

This fhip ieft England provided with every
thing that could be fuppofed to conduce to
the health of men, and may be coniidered
.as an experiment to prove what degree of
■health may be attained by proper manage.-
■ment and attention. She was furnifhed not
only with abundance of four Jcrout, melafTes,
and eflence of malt, in common with the
.other (hips ; but what was peculiar to her,
was an entire fupply of excellent wine, in
place of fpirits, of which none was ufed
.during the period mentioned.

H 4 CHAR

* ■
i

[ io4 ]

CHAP. IV.

Account of the Health of the Fleet while it lay at
Jamaica during May, June, and Fart of July, 1782.

— French Prizes Caufes of Sicknefs — Their

Difference from the Englith in point of Cleanlinefs
and Difcipline — Bad Effects of Land-wind and
Watering Duty — Situation of Port Royal — Seafon
uncommonly dry and windy — Fluxes more prevalent
at Sea than in Harbour — Comparifon of the Sicknefs
at this Time with that of the Army and with that of
the Squadron under Admiral Vernon forty-one Years
before — Effects of Contagion and foul Air— r Officers
more afFe£ted„than the common Men.

ALL the fquadron that was left to wind*
ward of Jamaica, confiding of twenty-four
fhips of the line, kept the fea during great
part of May, the laft divifion of it not ha-
ving come to Port Royal till the 25th of
that month.

The whole fleet remained in harbour du-
ring the remainder of the month, and the

whole

Book n» diseases of the fleet, 1782. 105

whole of the next, except the Warrior,
Prothee, and Ruffell ; the two former were
fent on a cruife, in which the Warrior con-
tinued quite healthy, as fhe had been ever
fince her arrival from England ; and in the
Prothee a great check was given to the fe-
vers and fluxes which had begun to prevail
at Port Royal. The Ruifell was fent to
England with a convoy.

TABLE,

toS DISEASES OP THE FLEET, T782. fART I.

*FABLEr fhewing the proportional preva-
lence of Sicknefs and Mortality in May*

■

DISEASES,

>
i

Proportion of thofe ta*
ken ill or wounded
in the Courfe of the
Month.

Proportion of thofe that
died in relation to
the Numbers of fick
or wounded.

; Fevers - -

I 26.

! Fluxes ;■ .- - - - -

j Scurvy - - - -

34 ;

ij Wounds - -

1 : .

Other Complaints -

627

60 ■
127

j General Proportion, ■>
including wounded J

General Proportion, i
! exclusive of Wounds j

. 7i

Thi

BOOK IJ. DISEASES OP THE FLEET, 1782* IO7

The whole number of fick on board on
the firft of this month, in thirty-fix mips
of the line and two frigates, upon which
the preceding calculation is formed, was 141 8.
The whole number taken ill in the courfe
of the month, was 2828 ; the number fent
to the hofpital was 173, and there died on
board 94.

The proportion of thofe who died this
month, in relation to the whole number on
board, was one in 287.

There was a confiderable increafe of lick-
nefs and mortality this month in all the
common difeafes, and chiefly in that part of
the fquadroii which was in port. There
was lefs increafe in the number of fevers
than either of the other two epidemics ;
but fuch was their increafed malignancy,
that more died of them than of both the
others. The number of fluxes was
more than double wrhat it was the pre-
ceding month, and the mortality from
them was alfo in a much greater proportion,
as maj be feen from the tables.

The

SOS DISEASES OF THE FLEET, 1 782. PART I.

The fevers prevailed chiefly in port, and
the fluxes at fea. A good many of the lat-
ter, indeed, arofe in the Alcide, though
conitantly in port ; but this feemed to be
owing to contagion conveyed by fome Bri-
tiihu foldiers, who were fent on board of
this ihip after being re- taken in one of the
French- men of war, and feveral of them
were ill of this difeafe. But there were
lew/ fluxes in thofe mips at Jamaica in which
the moil malignant fevers appeared. There
were a few in thofe in which the fevers
arofe from the air of the marfhes on the
watering duty ; but there were none on
board of the French prizes, nor in thofe
Haips In which that fort of fever was, which
proceeded from a fimilar caufe, that is, filth
and animal effluvia. Upon the whole, in
thofe mips in which the fever was moll: ma-
lignant, there the feweft fluxes were found?

Several circumflances contributed to the
Increafe of ficknefs and mortality this
month.

I ft. The?

BOOK II. DISEASES OF THE FLEET, 17$ 2> I©£

ift. The infection, or rather the foul ak
of the French prizes, in mod of which a
very bad fever broke out among the officers
and men that were fent from the (hips of
our fleet to take charge of them.

The difcipline and internal oeconomy of
the French fhips of war are greatly inferior
to thofe of the Britifh. Their decks are
never warned, and there is a great defect m
every point of cleanlinefs and order. Tlae
free courfe of the air is oMtrutted by lum-
ber of every kind, and by bulkheads, which
are not taken down even in the time of
battle ; and the gratings are covered night
and day with tarpaulins, even in a hot cli-
mate. There are not even fcuppers openeJ.
on the lower deck as outlets to the water
and filth, which iveceffarUy accumulate
there, and for which the only vent is a
pipe contrived on purpofe, paffing from that
deck along the mip's fide into the hold,
which becomes thereby a common fink,' in-
conceivably putrid and ofFenfive. And in
addition to the ordinary caufes of corrup-
tion, there was one peculiar to the occasion ;

for

HO DISEASES OF THE FLEET, 1782. PART U

for the blood, the mangled limbs, and even
whole bodies of men, were caft into the
orlop, or hold, and lay there putrifying for
fome time. The common failors among the
French have a fuperfKtious averfion to the
throwing of bodies overboard immediately
after they are killed, the friends of the deceafed
wifhing to referve their remains, in order to
perform a religious ceremony over them when
the hurry and danger of the day ihall be over.
When, therefore, the ballafr,, or other con-
tents of the holds of thefe fhips, came to be
flirred, and the putrid effluvia thereby let
loofe, there was then a vifible increafe of
ficknefs. For the firit three weeks after the
capture, the flench proceeding from the
numbers of wounded men contributed alfo
to taint the air.

The Ville de Paris was much more fickly
than the other prizes, not only from her
being larger, and thereby containing a grea-
ter mafs of foul air, but by receiving the
furviving part of the crew of the Santa Mo-
nica, one of our frigates, which had been
cait away pn the Virgin Iflands, and whofe

men

fiOOK II. DISEASES OP THE FLEET, I7S2. Ill

men were fo reduced by hardfhip and intem-
perance, that mofi of them were taken ill
as foon as they came to breathe the unwhole-
fome air of the French prize. To what-
ever caufe it was owing, the fever was much
more violent here than in the other prizes,
and it generally carried men off on the third
or fourth day ; and what is remarkable, the
officers were affected by it in a greater pro-
portion than the common men. One lieu-
tenant and every warrant officer, except the
boatfwain, died of it. This was a proof that
the ficklinefs was owing to the bad air, and
not to the intemperance and irregularity fo
ufual on board of prizes, which only the com-
mon men give into ; and the probable caufe
of the officers being moil: affected is, that
they were accuftomed in common to a purer
air, by living in the moil clean and airy parts
of the fhip,

It is alfo remarkable, that the Vi-lle de Park
was healthy when taken, and had been fo
ever fmce leaving France in March 1781,
nor had any other of the captured mips of
the line been fickly for fome time before,
2 except

112; DISEASES OF THE FLEET, I7S2. FART X.

except the Ardent, when (Tie arrived at Mar-
tinico four months before, at which time
the greater part of the crew were fent to the
hofpital with fevers. This, as well as other
facts of the fame kind, tends to prove, that
when men come to be much habituated to
bad air, their health is not affeded by it.

The French (hips were purified by warn-
ing and fcraping, by fumigating daily with
gunpowder and vinegar, and by the ufe of
wind-fails. But nothing feemed to contribute
fo much to fweeten the air in them as burn-.
ing fires in the hold ; for this tended both to
make the putrid matter exhale, and to carry
it off, by producing a perpetual change of air.
Captain Curgenven, wrho at this time com-
manded the Ville de Paris, had great merit,
from his very afliduous and fuccefsful endea-
vours in fo difficult a duty as the manage-
ment and equipment of this great fhip. In
confequence of the judicious meafures taken,
and the men becoming more ufed to the bad
air, the ficknefs ceafed in the courfe of a few
weeks.

»00K l\. DISEASES OF THE FLEET, 1782. II3

In the accounts given in the tables, the
French prizes are not included, for the dis-
orderly ftate in which they were at this time
prevented yriy receiving regular returns :
but having made inquiry concerning the
mortality in the Ville de Paris, I found
that of a crew of 312 men, there died ten.
in the month of May, and there were thirty
fent to the hofpital, whofe cafes were fo un-
favourable, th-it about one half died. The
only difeafes were fevers. The furgeon of the
Ardent told me about the fame time, that
one third of the crew of that Ihip was ill of
fevers.

The fecond caufe of the prevalence of
ficknefs, while the fleet was at Jamaica,
was-, the watering duty, which was carried
on at Rock-fort, about three leagues from
Port Royal. It was the practice of many
of the fhips to leave the water calks on more
all night, with men to watch them ; and as
there is a land wind in the night, which
blows over fome ponds and marines, there
were hardly any of the men employed on
that duty who were not feized with a fever of

I a very

114 D.ISEASES OF T"HE FtEET, 1^82. PART I.

a very bad fort, of which a great many died.
The mips that followed a different practice*
were fomewhat longer in watering ; but this
was much more than compenfated by their
preferving the health and faving the lives of
their men.

The land-wind which blows on the more
in the night time, is a circumftance in which
Jamaica differs from the fmall iflands to-
windward, over which the trade wind blows,
without any interruption : but though this
land wind blows upon Port Royal from
fome marmes at a few miles distance, it does
not feem to produce fkknefs, for it is a very-
healthy place, and feveral of the mips en-
joyed as good health as in the bell: Situations
on the windward ftation. The bay which
forms this harbour is bounded towards the
Tea by a peninfula of a lingular form,
being more than ten miles in length, and
not a quarter ' of a mile broad at any
part. Great part of it is fwampy and
overgrown with mangroves, and though
of fuch fmall extent, we fancied that fome
of the (hips that lay immediately to leeward
of this part were more fickly than thofe that
2 were

BOOK II. DISEASES OF THE FLEET, 1782. 1 15

were clofe to the town of Port Royal, which
ftands at the very extremity of this long
peninfula upon a dry, gravelly foil.

The weather this month was uniformly
dry in port ; but at fea the air was moifl
and hazy. Between Jamaica and Hifpaniola,
where part of the fquadron was left to cruife,
dead calms prevailed, and this, joined to the
moifture of the air, was probably what
caufed the flux to prevail chiefly in this part
of the fleet. At Port Royal, on the con-
trary, there was a ftrong dry breeze, which
fet in every day about nine o'clock in the
morning, and blew all day fo frefh, that
there was frequently danger in paffing from
One (hip to another in boats. This is called
in the language of the country, the fiery fea
breeze, an epithet which it feems to have
got not from its abfolute heat, but from the
feverifh feeling which it occafions by drying
up the perfpiration. It was remarked, that
this breeze was ftronger this feafon than had
ever been remembered ; and it fometimes
even blew all night, preventing the land
breeze from taking its ufual courfe. This

I z year

Il6 DISEASES OF THE FLEET, 1782. PART L

year was farther remarkable for the want of
the rains that were wont to fall in the
months of May and June. We mail have
occafion to remark hereafter, that this was
a very uncommon feafon alfo in Europe
and America. The heat, by the thermome"
ter this month, on board of a fhip at Port
Royal, was in general, when loweft in the
night, at 770, and when higheft in the day,
in the (hade, at 830.

There was a confiderable increafe of fcurvy
in this month, compared with the former
months of this campaign ; but very inconfi*
derable, compared with what had occurred
in cruifes of the fame length in former
years. The lafl divifion of the fleet had
been at fea feven weeks all but one day
when it arrived at Port Royal, and
though the fcurvy had appeared in feveral
of the mips, it did not prevail in any of
them to a great degree, exeept in the Non-
fuch. Out of fourteen deaths which hap-
pened in the whole fleet from this difeafe,
in May, feven of them were in this fhip,
and feveral were fent from her to the hofpi-

tal

300K II. DISEASES OF THE FLEET, 1782. 1 17

tal in the laft and moft defperate ftage of it.
But, upon the whole, the cafes of the true fea
{curvy in the fleet in general were few and
flight, and a great many of thofe given in
the reports under the head of fcurvy, were
cutaneous eruptions or ulcers, not properly
to be claffed with it.

The cruife in the preceding year to wind-
ward of Marti nico, may be compared with
that in May of this year ; for the fleets in
both cafes had been at fea about the fame
length of time. But the comparifon is very
greatly in favour of the latter, which is moft
probably to be imputed to the plentiful fup-
ply of melaffes, wine, four krout, andeflence
of malt. But no adequate reafon that I
could difcover can be afligned for the preva-
lence of it in the Nonfuch, to a degree fo
much more violent than in the other (hips ;
and it was here farther remarkable, that it
attacked every defcription of men indifcrimi-
nately ; for I was allured by the officers and
by the furgeon, that not only the helplefs
and difpirited landfman was affected, but old
feamen who had never before fuffered from

I 3 it

Jl8 DISEASES OF THE FLEET, I782. PART 1,

it on the longeft cruifes. I have been led by
this, and fome other facts, to fufpecl: that
there may be fomething contagious in this
difeafe.

JUNE,

The greater part of the fleet remained at
Jamaica during this month, refitting and
watering. Twelve mips of the line were
fent to feaon the 17th, under the command
of Rear-admiral Drake, but not being able
to get to windward, on account of the freiTi
breezes that prevailed, they returned to Port
Royal on the 28th. Such of thefe mips
as were fickly, became more healthy while
at fea, but fome bad fevers arofe, particu-'
larly in the Princeffa ; and it is a curious
circumftance, that thefe fevers attacked
only thofe men who had been on more on the
watering duty ; from which it would appear,
that fomething caught or imbibed, which
is the caufe of the fever, lies inactive for
fome time in the constitution, fome of the
men not having been affected for more than
a week after they had been at fea.

The

»jQO*K H. DISEASES OF THE FLEET, 1782. H9

The weather continued dry and windy, as
in the farmer month ; but the heat was in
general about two degrees higher, the ther-
mometer varying from 79 ? to ,841.

TABLE, mewing the proportional Sick-
nefs and Mortality in June.

DISEASES.

Proportion of thofe
taken ill in the
courfe of this
Month ;.

Proportion of thofe
who died in rela-
tion to the Num-
bers of the Sick.

Fevers -
Fluxes - -
Scurvy - -
Other Complaints

w <

0 \

1 1

20
47

f 19

231

■

. 39

General Proportion

The

IZO DISEASES OF TttE FLEET, 1782. PAK-T 1.

The proportion of deaths in relation to the
whole numbers on board, was one in 13&.

There was only one in 30 of the lick fent
to the hofpital in the courfe of this month.

There was an increafe both in the numbers
and fatality of fevers, This increafe was
chiefly in that fort of fevers that depend on
the air and climate, the greater part of which,
were caught on the watering duty. There
was a diminution of thofe fevers depending
on infection, and the foul air of mips, which
arofe in the French prizes. The care that
was taken in purifying thefe mips was very
effectual, for only four died this month in
the Ville de Paris, and fewer alfo were fent
to the hofpital than in May. The increafe of
the other kind of fever was chiefly owing to.
there being a greater number of mips in port,
and partly, no doubt, to the increafe of heat.
The (hips in which the fevers were moll: fatal
were the Monarch, the Duke, the Torbay,
and the Refolution. The fkknefs in the
Duke was frill in a great meafure owing to
the fame infection that had hitherto prevailed,
for this fhip had never been cleared of the

infectious

BOOK XI. DISEASES OF THE FLEET, 1782. 121

infectious fever, for want of room at the hof-
pital. That which broke out intheTorbay
was alfo of the low infectious kind, few of
them haying the fymptoms of that which is
peculiar to the climate, which prevailed in
the other fhips. This fhip, though formerly
very fubject to infectious complaints, had
been remarkably healthy for fome time pair. ;
but it would appear that there was a large
flock of latent infection, which {hewed itfelf
from time to time.

Some fhips, particularly the Montague,
and Royal Oak, had no increafe of fevers,
or other complaints, though the one lay in
port for feven, and the other for eleven weeks,
and were more or lefs expofed to the caufes
of licknefs which affected the reft of the fleet.
This is a proof, among many others, that a
particular combination of caufes is necelTary
to produce a difeafe ; no tingle one, however
powerful, being fufficient, without the con-
currence of others. What feemed to be
wanting here was the predifpofition requifite
for the admiffion of difeafe into the confti-
Jution, for the (hips that enjoyed this happy

exemption,

122 DISEASES OF THE FLEET, 17S2. PART I.

exemption, were fuch as had long-eflablifhed
and well-regulated crews, accuftomed to the
fervice and climate.

There had been this month a diminution
both of the numbers and mortality of flux«s,
which is agreeable to what was before re-
marked, that fevers were more apt than
fluxes to prevail in the bad air of a harbour*.
It was alfo before remarked, that there were
few or no fluxes in thofe mips in w7hich the
fever was moit malignant, and now that the
fever began to grow more mild in the French
prizes, the flux began to appear. In the
Barfleur, Duke, and Namur, both difeafes
feemed to prevail equally ; but the fevers,

* I have feen an account of tbe difeafes of the army at
Su Lucia for a whole year, kept by Mr. Everard Home,
an ingenious gentleman belonging to the army hofpital,
and it appears that during ten months out of the twelve,
the dyfentery was the predominant difeafe. This feems
to contradict the opinion, that the land air is more apt to
occafion fevers than fluxes ; but it is to be remarked that
the ficknefs of the foldiers on that iiland was not fo much
owing to the malignant influence of the air, the fituation
of the garrifon being high and airy, as to the bad accom-
atodations and prcviiions, together with hard labour.

though

BOOK II. DISEASES OF THE FLEET, 1782. I23

though numerous, were rather of the low
nervous kind than bilious or malignant ; and
the fluxes chiefly attacked thofe who were
recovering from fevers. We may farther re-
mark, that thefe three men of war were three-
decked (hips, of po guns, with more mixed
and numerous crews than fmaller mips, and
therefore fubjedl: to a greater chance of infec-
tion, and a greater variety of complaints.
The Formidable frill remained healthy to an
extraordinary degree. Some fevers were in-
deed imported from the Ville de Paris by men
that had been lent to that fhip, and who
were taken ill after their return. Of thefe a
few of the worfr. cafes were fent to the hof-
pital, and two died on board, who, with one
that died the preceding month, make the
whole mortality of this fhip, uiice leaving
England, amount only to the lofs of th ree men.

There has been little or no increafe of
fcurvy this month ; for though the num-
bers put on the lift appear to be greater, the
mortality is much lefs. It may indeed ap-
pear a matter of furprife that there mould
have been any fcurvy at all, confidering that

the

124 DISEASES OF THE FLEET, 1782. PART J.

the greater part of the fleet was at anchor
all this month. But as this was the greateft
fleet that had ever vifited Jamaica, it was
impoffible to find frefh provifions for the
whole, and the fmall fupply they had did
not amount to a frefh meal once a week.
Port Royal is alfo remote from the cultiva-
ted part of the ifland, fo that fruit and ve*
getables were both fcarce and high priced,
particularly this year, on account of the
ufual rains in May and June haying failed.
There was however an allowance of frefh
provifions and vegetables made to the fick
by public bounty ; for as the hofpital could
contain but a fmall proportion of the fick
and wounded, an order was given for the
fupply of frefh meat, fruit, and vegetables
to the fick, and five hundred pounds of Pe-
ruvian bark were alfo diftributed as a public
gratuity, befides fugar, coffee, and wine.

With thefe aids, and the various good
articles of victualling from England, the
fleet was preferved uncommonly healthy
for a Weft-India campaign. For though
the mortality had increafed confiderably du*-

ring

BOOlC II. DISEASES Of THE FLEET, I}§2. 12$

ring our flay at Jamaica, yet the lofs of
men upon the whole was fmall, compared
with that of other great fleets in this cli-
mate on former occafions. The greateft
fquadron next to this, that had ever been on
this ftation, was that under Admiral Ver-
non in the year 1741, at the fame feafon.
From this fleet upwards of 11,000 men
were fent to the hofpital in the courfe of
that and the preceding year, of whom there
died one in feven, befides what died on board
of their own mips and in two hofpital
fhips*. The difproportion of licknefs in
the two fleets will appear ftill greater when
it is considered that Admiral Vernon's con-
tained only-j- 15,000 feamen and marines,
whereas that under Lord Rodney contained
22,000. What added to the ficknefs of
the former, was the unfortunate expedition
to Carthagena in April, 1741 ; to which
probably it was owing that a much greater
proportion of yellow fevers were landed
from the fleet at that time than from ours,

* See EfTay on the Yellow Fever, by Dr. Hume.
f Campbell's Lives of the Admirals.

126 DISEASES OF THE FLEET, 1782. PART 1.

as appears by the papers left by Mr. Hume,
who was then furgeon of the hofpital. The
hofpltal was then at a place called Green-
wich, on the fide of the bay oppofite to
Port Royal, and was very large ; but it was
found to be in a fituation fo extremely un-
healthy, that it was foon after abandoned
and demolifhed, and the hofpital has fince
been at Port Royal.

It appears by the tables, that a greater
number was put on the lift under the head of"
ether complaints this month than laft. This
was owing to the great number of ulcers
which I have remarked to keep pace with
feverifh as well as fcorbutic complaints ;
for when the conftitution of the air is fa-
vourable to difeafe, or the habit of body
prone to it, wounds and fores are found
then to be more difficult of cure. There
were twelve deaths befides thofe occafioned
by what have been called the three epide-
mics. Of thefe, five periflied by drowning
and other accidents, , three . died of ulcers,,
one of wounds received in action, one of
cholera morbus 7 and one of an abfeefs.

BOOK II. DISEASES OF THE FLEET, 1783. I27

It has appeared that very few mips of
this numerous fleet preferved their health
while lying at anchor ; and it would feem
that fhort and frequent cruifes are very con-
ducive to health. It was eleven weeks from
the time that the firft of our fleet came to
anchor at Jamaica till the main body of it
failed for America on the 17th of July.
Great fleets are in time of war under the ne-
cefTity of being at one time longer at fea,
and at another time longer in port, than is
confident with the health of the men,
the mips being obliged to act in concert
and to co-operate with each other. This is
one reafon, among others, for mips of the
line being more fickly than frigates. As
fhips of war muil be guided by the unavoi-
dable exigencies of fervice, it would be afe-
furd to confider health only ; but if this
were to be the fble object of attention, a cer-
tain falutary medium could be pointed out in
dividing the time between cruifing and being
in harbour, and it is proper that this .mould
be known, that regard may be had to it, as
far as may be confident with the fervice. I
would fay, then, that in a cold climate men

ought

125 DISEASES OF THE FLEET, f]M, FART I.

ought not to be more than fix weeks at fea at
one time, and need not belefs than five weeks,
and that a fourth part of their time fpent in
port would be fufficient to replenish their
bodies with wholefome juices* In a warm
climate, men may be at fea a conliderable
time longer, without contracting fcurvy,
provided they have been under a courfe of
frefli and vegetable diet when in port.

Though contagion is not fo apt either
to arife or to fpread in this climate as in
colder ones, there were feveral circum-
ftances about this time, tending to prove
that it may really exift in a hot climate.
Thofe (hips which had their men returned
to them from the French prizes, in all of
which fevers prevailed, had an increafe of
licknefs not only in the men that. were re-
turned, but in the reft of the crew. There
was another prefumption of contagion, from
the proportion of mortality among the fur-
geons and their mates, who were by their
duty more expo fed to the breath, effluvia,
and contact of the fick. There died, during
our ftay at Jamaica, three of the former

and

"v.. -

BOOK I!. DISEASES OF THE FLEET, 1782. 129

and four of the latter, which is a greater
proportion than what died of any other clafs
of officers or men.

It has been the opinion of fome, that fe-
vers do not arife from any putrid effluvia,
except thofe of the living hu man body, or fome
fpecific infection generated by it while under
the influence of difeafe. It has been alledged
in proof of this, that the putrid air in fome
great cities is breathed without any bad ef-
fects ; and a celebrated profeflbr of anatomy
ufed to obferve, that thofe employed in dif-
fering dead bodies did not catch acute difeafes
more commonly than other people. I believe
this may be true, in a climate like Europe,
where cold invigorates the body, and en-
ables it to refifl the effects of foul air ; but I
am perfuaded it is otherwife in tropical cli-
mates. The external heat of the air induces
great languor and relaxation, and we cannot
breathe the fame portion of air for the fame
length of time in a hot as in a cold climate,
without great uneafinefs. The want of cool-
nefs muft, therefore, be compenfated by a
more frequent change of air, and by its
greater purity. Any foulnefs of the air is

K accordingly

Z$0 DISEASES OF THE FLEET, 1782. PART 1.

accordingly more felt in a hot climate, and
according to the modern theory, air already
loaded with putrid phlogiftic vapour, will-
be lefs qualified to abforb the fame fort of va-
pour from the blood in the lungs, in which,,
according to this theory the ufe of refpira-
tion confifts. Be this as- it will, there is
fomething in purity of air which invigorates
the circulation 7 and refreshes the body ; and
the contrary ftate of it depreffes and debili-
tates, particularly in a hot climate -9 and in
this Way foul air may induce difeafe, like any
other debilitating caufe, independent of in-
fection or any fpecific quality. There was no
reafon to fufpect any fuch infection in the
^Ville de Paris, for there was no ficknefs on
board of this fhip, when in poffeffion of the
enemy, and the ficknefs that prevailed after its
being captured feemed to proceed from what
may be called fimple putrefaction. There
was an inflance of the fame kind in one of
our own mips of the line, in which a bad
fever broke out in the beginning of July,,
which feemed to be owing to the foul air of
a neglected hold ; for there was a putrid
flench proceeding from the pumps, which

pervaded

SOOK II.- DISEASES OF THE FLEET, I7§2. IJE

pervaded the whole fhip. I perceived this
very fenfibly one day, when vifiting fome
officers who were ill of fevers ; and before I
left the fhip, ao alarm was given of two men
being fuffocated in what is called the welly
which is the loweft acceffible part of the
hold. This fever was of a very malignant
kind, and fell upon the officers more than the
men, for fix of them were feized with it, of
whom three died on the third day after being
taken ill.

The fevers, which were of the greatefr. ma*
lignity at this time, affected the officers more
than the common men. Only one Captain
died at Jamaica while the fleet was there,
and it was of this fever* We loft five Lieu-
tenants, of whom four died of it, and this
was the difeafe which carried off the three
Surgeons. But foul air was not the only
caufe that produced this fever among the
officers, feveral of whom brought it on by
hard drinking, or fatiguing themfelves, by
riding or walking in the heat of the fun.
It cannot be too much inculcated to thofe
who vifit tropical countries, that exercife in

K 3 the

SJ2 DISEASES OF THE FLEET, 1)82. FART I.

the fun, and intemperance, are mod perni-
cious and fatal practices, and that it is in ge-
neral by the one or the other that the better
fort of people, particularly thofe newly ar-
rived from Europe, fhorten their lives.

Before leaving Jamaica, I fent to England
a Supplement to the Memorial given in lafl

year *,

* See Appendix to Part II«

CHAP.

I l33 J

CHAP. V.

Account of the Health of the Fleet, from its
leaving Jamaica on the 17th of July, till its De-
parture from New York on the 25th of October.

What Difeafes mod prevalent on the Paflage

to America — Rapid Increafe of the Scurvy during
the laft Week of the PaiTage — Method of fupplying
the Sick at New York — The Fleet uncommonly
fiealthy in October — State of the Weather and of
Health in America in Summer and Autumn, 1782.

A H E feafon of the hurricanes approach-
ing, and all the convoys defined for Eng-
land this year being difpatched, the main
•body of the fleet, conllfting of twenty-four
fhips of the line, left Port Royal on the
17th of July, under the .command of Ad-
miral Pigot, in order to proceed to the coall
of America. A great convoy for England
had been fent off a few days before, pro-
tected by the Ville de Paris and fix other
£hips of the line, which we overtook and

K 3 pafled

^34 DISEASES OF THE FLEET, 1782. PART I.

palTed at the weft end of the ifland. When
we arrived off the Havannah, a large fqua-
dron of the enemy was feen there in readi-*
nefs to fail, which induced the Admiral to
wait in fight of it for the convoy, which
did not come up till ten days after. Owing
to this delay, and our meeting with baffling
winds on the reft of the palfage, we did not
arrive at New York till the 7th of Septem-
ber. We found there the Invincible and
Warrior, which failed after us, but got be-
fore us,- by having taken the windward
paffage.

TABLR

B'00'K II. DISEASES OF THE FLEET, 1 782. 1 35

TABLE, (hewing the proportional preva-
lence of different difeafes, and their mor-
tality, in July, 1782.

DISEASES.

Fevers - - -
Fluxes - - -
Scurvy ■« - -
Other Complaints

*-? . r! ,n

0=5 °

c ""'
.2 c

4-1 <u

£ <*
o

P o

8£

General Proportion

2 <U 4)
tJ *J ♦-

<u 0

Hs c

0 s

1-4

4_l 0)

6 y

*- !-.

S 0

#■.£

JZTeo -

P-.

■
49

■ O :

ft
O

134

■

•5 ^

The mortality this month, in relation to
the whole numbers on board, was one in
1.30.

There were only one in thirty-eight of
the iick fent to the hofpitals.

Tho

I36 DISEASES Or THE FLEET, 1782. PART I.

The fevers arofe chiefly during the firfl
two weeks after leaving Jamaica, and there
is reafon to think that the feeds of them
were brought from thence. It could not
be owing fimply to the heat ; for the tro-
pical heats at this feafon of the year ex-
tend to the 30th degree of latitude, which
we did not crois till the 22d of Auguft,
that is, near five weeks after leaving Ja-
maica. The only fhips in which the fever
could be imputed to infection or foul air,
were the Barfleur, Alcide, and the Aimable
frigate. The firft had received, as recruits,
at Jamaica, men who had been confined for
fome time before in a French jail, and a fe-
ver of a bad kind fpread on board of her
foon after. The Aimable was a prize from,
the French, and the ficknefs was here fo
evidently owing to fowl air, that whenever
the contents of the hold were flirred fo as to
Jet loofe the putrid effluvia, there was then
an evident increafe of ficknefs. The fewer
in the Alcide was of a peculiar flow kind,
to be defcribed hereafter, and feemed to be a
continuation of the fame infection which
jiad fo long exifted in that fhip.

Thq

BOOK II. DISEASES OF THE FLEET, I782. 1 37

The Duke, which had hitherto been by
far the moft fubjecT: to fevers of any fhip in
the fleet, became more and more free from
them even in the moft early part of this
pafTage, and might be faid to be entirely fo
at the time (he arrived in America. The
fever had been fo very prevalent in this fhip
fmce leaving England, that there was hard-
ly a man who had efcaped it. Could this
have any effecT: in making them lefs liable to
catch it a fecond time ?

In the courfe of this pafTage the dyfente-
ries came, to prevail over the fevers, as we
have found to be commonly the cafe at fea.
It appears by the former table, compared
with the next, that the mortality in fevers
was much the fame, and that in the dyfen-
tery it was greater than while the fleet was
at Jamaica. This does not argue, however,
that the difeafes were equally malignant,
but was owing to the want of an hofpital,
and of thofe comforts of diet which the lick
enjoyed on board while in harbour. This
laft was particularly felt in the dyfenteries,
in the cure of which more depends upon

diet

I38 DISEASES OF THE FLEET, 1782. PART I.

diet than in mofl other difeafes. In all the
calculations of mortality, the numbers fent
to the hofpitais are deducted ; but thefe make
a greater difference in the mortality on board
than their numbers (Imply would indicate ;
for only the worft cafes, and thofe therefore
who were moit likely to die, ufed to be fent
to the hofpital.

Tx\BLE, (hewing the proportional ficknefs
and mortality in AugufL

' DISEASES.

ion of thofe

ill in the

e of the

on of deaths
ation to the
3ers of the

. - 1 11

•op.orj

taken

Mont

•oport
in rel
Num
Sick.

P-

Fevers -

\ 31

Fluxes - -

Scurvy -

Other Complaints

General Proportion

. 7i

I 3l

The

BOOK II. DISEASES OF THE FLEET, I782. I39

The mortality this month, in relation to
the whole numbers on board, was one in
169.

None were fent to the hofpital this
month, as the fleet was at fea during the
whole of it.

The fcurvy began to appear very foon
upon this paftage ; for by the end of Au-
guft, at which time the fleet had only been
fix weeks at fea, and that in a warm cli-
mate, and in dry weather, it had made coa-
fiderable p'ugrefs. It firft appeared and pre-
vailed moft in the Prince George and Royal
Oak, though they had been ten weeks at
Jamaica. This was the firft licknefs with
which the latter had been affected lince ar-
riving in the Weil Indies, and there was no
perceivable peculiarity in either of them to
account for their being mbje£t to it more
early, or more violently, than the reft of
the fleet. If the difeafe is contagious, as
has been fufpected, there might be a few
men on board of them, who, being uncom-
monly prone to the difeafe, would be foon

affected^

I4O DISEASES OF THE FLEET, I7S2. PART I,

affected, and communicate it, or at lead
haften the fymptoms in thofe who might be
lefs predifpofed to it. But this is only con-
jecture. Before the end of the voyage, the
whole fleet was more or lefs afflicted with it,
though it had been only feven weeks and
three days at fea ; but the men had received
fo few refrefhments while in port, that their
constitutions were prepared to fall into this
difeafe. The Barfleur, Alfred, and Prin-
cefTa, were moft affected with it next to the
two (hips mentioned above,

The feven teen mips which arrived from
England in February and March, were
much lefs affe&ed with it than the reft of
the fleet, which was, no doubt, owing to
the wine, melafTes, and four krout, with
which they were fb amply fupplied. Though
thefe articles were all expended before leav-
ing Jamaica, yet the good effects of them
on the conftitutions of the men were vifibfcs
in the courfe of this parage.

The America was the moft free from it of
all the fhips of the old fcjuadron ; and this

was

BOOK Il» DISEASES OF THE FLEET., 1782. 141

was owing to the great humanity and atten-
tion of the captain, who, as foon as any of
the men were taken ill, allowed them wine
and other refrefhments from his private {lore.
There was another proof in the Conqueror
of the great importance of attending to this
difeafe in its earlieft ftage. Mr. Lucas, the
furgeon of this mip, by watching the firll
beginnings of it, by a proper regulation of
diet and the adminiftration of the effence of
malt and juice of limes, not only prevented
the progrefs of the difeafe, but proved that
with great attention it may be cured at fea.
It is of the utmoil confequence in this dif-
eafe to put the men on the fick lift on the
very firft appearance of the fymptoms, fo
that they may early have the advantage of
proper treatment and regimen. It is only
at this period of it that the effects of ef-
fence of malt are fenfible ; but we have feen
that the juice of gertain fruits will cure it in
more advanced ftages.

There is a very important remark fuggeft-
ed by comparing the two preceding tables with
that which follows. It appears that in the

month

142 DISEASES Off THE FLEET, 1782. PART I.

month of September a much greater number
was taken ill of fcurvy, and that of thefe, a
greater proportion died than in the two prece-
ding months. All the mifchief from this
difeafe in that month, happened in the firft
week of it, during which, as many died as in
the whole month of Auguft ; for the fleet came
to an anchor on the 7th of September at New
York, where the worfr. cafes were imme-
diately fent to the hofpital, and thofe that
remained on board were fupplied with every
neceflary refreshment. Had the fleet re-
mained longer at fea, the mortality would
probably have increafed in the fame progref-
flon ; and this circumftance ought to be
well conlidered in undertaking cruifes. j

TABLE,

BOOK II. DISEASES OF THE FLEET, 1782,

14 3

TABLE, mewing the proportional preva-
lence of ficknefs and mortality in Sep-
tember, 1782.

- ....
DISEASES.

Proportion of thofe
taken ill in the
courfe of the
. Month.

£ <o <u ■

a 5 "

w <-> 0

0 § 2

c *.£ o>

1-.
Pj.

Fevers
Fluxes -
Scurvy -
Ulcers -
Other Complaints

' 49

If*

31
68

39
0

226

General Proportion

: 7

L ^

The proportion of deaths, in relation to
the whole numbers on board, was -one in

About

144 DISEASES OF THE FLEET, I782. PART I«.

About one third of all the lick were fent
to the hofpital.

As the proportion of ulcers was uncom>
monly great, I thought it worth while to
make a calculation of it. The Barfleur had
the greateft number ; and this fhip, for
caufes I cannot affign, was more afflicted
with bad ulcers than arty other in the fleet,
for feveral months together.

The fleet having arrived at New York in
this unhealthy ftate, the firft care was to
make provision for the fick. There were
fomewhat more than 1500 on the fick lifts
of all the mips, and the hofpital could ac-
commodate little more than fix hundred.
In order that it might not be overcrowded,
and that each fhip might have a jufl (hare of
relief, I went round the fleet to afcertain the
due proportion of thofe cafes that were the
moll: proper objects for being fent on more.
All the infectious and acute complaints, and
fome of the worft fcorbutics, were accord-
ingly fent to the hofpital. Thofe who were
kept on board being chiefly fuch as were

affected

BOOK Hi DISEASES OF THE FLEET, 178^ 1^5

affected with the fcurvy, were fupplied with
various refreshments in their refpective mips,
and feemed to recover as foon as if they had
been fent on fhore. They had indeed alrnofl
every advantage enjoyed by thofe at the hof-
pital ; for, befides frem meat thrice a week,,
and fpruce beer daily in common with the
other feamenj each man on the fick lift was
fupplied every weelc at the public expence
with four pounds of apples and half a pound
of foap. There were alfo thirty cafks of
limes taken in a prize, which were diftrii
buted among the fcorbutic men, and proved
of infinite ufei Admiral Pigot's great zeal
for the good of the fervice, as well as his
natural humanity, induced him to liften to
whatever was propofed for the benefit of
the men*

The fupply of foap was a thing entirely
new in the fervice ; but the good effect of
all the other articles would moll; probably
have been defeated, unlefs the men had beeli
furnifhed with the means of eleanlinefs,
which is the molt ehential requifite of health.
The advantage of this method will appear

L by

14-6 BISEASES OF THE FLEET, 1782. J?ART I*

by the returns of next month to have been
very confpicuous, and it was on this occafion
more than any other thatlfawrealifedinevery
particular the plan propofed in the memorial to
the Admiralty. It may be added, that the ficfe
that were left on board were not even with-
out the recreation of the more enjoyed by
thofe at the hofpital ; for moil of the cap-
tains had the attention to fend daily on more,
for amufement and exercife, fuch as were
able to walk. Thus there were all the ad-
vantages of an hofpital obtained at much
lefs expence to Government, and without
the rifque of intemperance, defertion, or in-
fection, which are the inconveniences con-
netted with an hofpital. What farther con-
tributed to health at this time was, a large
quantity of excellent wine with which the
fleet was fupplied.

TABLE,

BOOK II* DISEASES OP THE FLEET, I7S2. ttf

TABLE, flawing the proportional Sick*
nefs and Mortality in October, 1782*

4-> O W

v£ <u <u

2 »^a

6/-G A

•■?- ♦j

jz *-• *■*

«S oL*

S,^8

crj .

c ■** Ja

DISEASES,

.2 OS-S

e c S
0.-3

opor
take
Cou
Moi

'•5 £ •

O n3 *3 C/3

P-<

1-1

Fevers - - - -

" 45

'2 jo

Fluxes - - ' * -

Scurvy - • -

197

Ulcers -

181

fit

Other Complaints -

127

0
106

General Proportion

L I2J

The proportion of deaths in this Iftonth,
in relation to the whole number on board*
was only one in 1478.

L %

About

I48 DISEASES OF THE FLEET, 1782- PART U

About one in 29 of the fick was fent to
the hofpital.

There was, upon the whole, lefs ficknefs
and mortality this month than any other
during which I kept records of the fleet.
This was, no doubt, owing in part to the
climate, but was chiefly the effect of the
extraordinary attention paid to the refresh-
ments of the men. The fleet was here ex-
actly in the fame Situation, and at the fame
feafoiij two years before, but was not near
fo healthy.

Nor were the advantages derived from
the great plenty of refreshments, procured
at this time at New York, merely tem-
porary, for the men's constitutions were fo
much improved by them, that the part of
the fleet which remained under the com-
mand of Lord Hood was at fea for twelve
weeks without being affected by the fcurvy.
This Was chiefly to be afcribed to the re-
freshments ; for we have {qcu. that, in a
paSTage of feven weeks from Jamaica to
New York, the fleet was greatly afteded with
thefcurvy, in confequenceof not having had

the

300K II. DISEASES OF THE FLEET, 1782. I49

the advantages of frefh meat and vegetables
when laft in port. The climate had, no doubt,
alfo a (hare in keeping oft the fcurvy ; for the
greater part of the twelve weeks was taken
up in a cruife off St. Domingo ; and, I be-
lieve, it never was known that a fleet was fo
long at fea in a cold climate without being
very much affected with this difeafe.

It appears that, though the proportion of
fevers had increafed fomewhat this month
over that of fluxes, yet the former "were lefs
fatal ; and, I think, the true dyfentery is
more frequent in this climate, and more apt
to prove fatal in its acute ftate, than in the
Weft Indies. I have indeed preferred the
term flux to that of dyfentery, for this reafon,
that the fymptoms in many cafes did not rife fc
high as properly to conftitute dyfentery; and
the difeafe proves fatal in the Wefilndies more
frequently in the chronic than in the acute
ftate. The fluxes were daily gaining ground
when we left New York, and continued to
prevail to a great degree in the Magnificent,
which remained in that climate feveral weeks
after us.

L3 The

I50 DISEASES OF THE FLEET, 1782. PART I.

The climate and fltuation of the fleet
had a greater erTe£t. in diminiming ulcers
than any other complaints ; for the propor-
tion this month is little more than one third
of the laft.

The calculation for October was made
upon thirteen mips of the line, which failed
from New York on the 25th of that month.

The weather had then begun to grow
cold ; but few or none of the difeafes pecu-
liar to a cold climate had appeared. There
occurred while we were at New York, fe-
veral cafes of inflammation of the liver
among the officers and men who came from
the Weft Indies. It was remarked for-
merly, that this complaint hardly ever oc-
curred in the Well: Indies ; but it. would ap-
pear that the rending there difpofes to an in-
flammation of this organ upon changing to
a colder climate.

The preceding fummer had been uncom-
monly cold, not only in North America,
but in the whole temperate part of the
% northern,

BOOK II. DISEASES OF THE FLEET, I782. 151

northern hemifphere, fo far as I could learn
by inquiry. In confequence of this, the
crops failed in Europe, America, and the
northern parts of Aria. The fame circum-
ilance had a remarkable effect on the reign-
ing difeafes of the feafon at New York ;
for, inftead of the bilious complaints com-
mon in the end of fummer and in autumn,
a flight fever of the inflammatory kind had
prevailed? An epidemic catarrh had jfpread
all over Europe, and fome part of Afia, in
the earlier part of the year ; and perhaps
this was connected with the peculiar irate of
the atmofphere about this time. It was be-
fore obferved, that there was fomething un-
ufual in the irate of the weather at Jamaica
while the fleet lay there ; and it is poffible
that this might be owing to the fame gene-
ral caufe„

M PHAP,

[ *S» ]

CHAP. VI.

Account of the Health of the Fleet from its Departure
from New York till the Conclufion of the War — —
J?afTage to the Well Indies — Account of the Ships
there during our Ab fence — Arrival of a Squadron
from England — Of thefe, two Ships only were
healthy — Caufes of this — Inflammatory Complaints
in the Union — Probable Caufe of thefe — Com-
parifon of the two Squadrons — Increafe of Sick-
nefs from Recruits brought from England — from
French Prifoners.

THIRTEEN fhips of the line failed from
America for the Well: Indies on the 25th of
October, under the command of Admiral
Pigot, and the other half of the fleet was
left under Lord Hood, to watch the motions
of the French fquadron, which was then at
Bofton.

The day on which we left the coair. of
America- a ftorm came on, which lafled two

days ;

J^OOK II. pJSEASES OP THE FLEET, I782. !$£

days ; but the reft of the paflage being fair
and moderate, we arrived at Barbadoes on
the 20th of November, where the fleet
continued for the remainder of the month.

All the above-mentioned fquadron, ex-
cept two mips, is comprehended in the
calculation of the following table, and alfb
the Magnificent, Prudent, and Nonfuch.
The two laft had continued in the Well
Indies during our abfence.

TABLE,

l$4 DISEASES OF THE FLEET, 1782, PART I.

TABLE, (hewing the prevalence of Sick*
nefs and Mortality in November.

D IS EASES.

roportion ©f thofe
taken all in the
Courfe of the
Month.

oportion of Deaths
in rel avion to the
Number of Sick.

Fevers * -

' 54

* 25

J Fluxes - • , -

132

1 Scurvy -

Ulcers -

<
w 1
55

Other Complaints

IO3

General Proportion

. J5

. 77

About a fixth part of the whole lick were
fent to the holpital this month, and one half
of thefe were fent to the hofpital at Halifax
from the Magnificent.

The

JOOKII. DISEASES OF THE FLEET, 1^82. 1 55

The proportion of deaths this month, in
relation to the whole number on board, is
one in 887. %

Fewer were taken ill this month than the
preceding, but more in proportion died ;
which might partly be owing to the fiee£
having been more at fea, and partly to the
change of climate.

Fevers were now more numerous, and alio
more fatal than any other difeafe ; and we
fee them follow the contrary proportion to
fluxes in the progrefs to the fouthward, that
they did in our progrefs to the northward.
Thefe fevers prevailed chiefly in the Formi-
dable and Warrior. In the former it firfl: ap-
peared among fome men that had been
preffed at New York from a privateer, fome
of whom were feized a few days after our ar*
rival at Barbadoes with the yellow fever, and
they were the only inflances of it at this
time in the fleet.

The

I$S DISEASES OF THE FLEET, 1782. FART I.

The fcurvy continued to diminish, but the
ulcers increafed as we came into the torrid
2one.

Difeafes in general were fo flight and fo
few at this time, that the whole fquadron
from America fent only forty-eight men to
the hofpital at Barbadoes, from its arrival to
the end of this month.

It may be proper here to give an account of
fome of the fhips that remained on this fta-
tion, while the main body of the fleet was in
America.

The Prudent when fhe left us was ex-
tremely healthy, and continued fo till a flux
broke out in July, which was communicated
by fome men from a cartel, who were ill of
this difeafe. It fpread among the (hip's com-
pany, and prevailed for three months. The
only deaths during the feven months that
this fhip was feparated from the fleet, were
two from flux, and one from fcurvy, and
only twenty-five were fent to hofpitals. This
is a proof how much more healthy the wind-
ward

BOOK II. DISEASES OF THE FLEET, 1)82. 257

ward ftation is than that of Jamaica. The
fcurvy arofe at one time in a cruife of five
weeks, though there was no appearance of
it at another time in a cruife of fix weeks.
The caufe of this feems to be the difference
of the weather at the two periods, for it
was very wet in the former, and very dry in
the latter. The time in which this fhip was
mofr. expofed to ficknefs was while fhe was
under repair at Antigua, a fituation in which
hardly any fhip efcapes a fevere vifitation of
ficknefs ; yet this fhip was not at all affected
by it, which feemed to be owing to the un-
common pains taken by the Captain to pre-
vent the men from labouring in the fun du-
ring the hot part of the day.

The Nonfuch was five months feparated
from the fleet, during which time ten men
died. Nine of thefe died of fever, and one
of the dyfentery. She failed from Jamaica
for Barbadoes about the fame time that the
fleet failed for North America, and was nine
weeks on the pafTage. A fever was the pre-
vailing difeafe, and the feeds of it were pro-
bably laid at Jamaica in common with moll:

1$S DISEASES OF THE FLEET, 1782. PART U

of the other fhips that were there. The
fcurvy, which had formerly prevailed fo much,
arofe at this time ; but it was in a very mo-
derate degree, confidering the length of the
pafTage. None died of it, and few were fo
ill as to require being fent to the hofpitaL
Had this ihip gone into a colder climate,
like the others, it would probably have pre-
vailed to a greater degree. The whole num-
ber fent to the hofpitals for various com-
plaints, during the five months, was only
thirteen.

The Nymph frigate was the only other
fhip left in the Weft Indies, which is in-
cluded in the tables. There happened only
two deaths in her from June to October,
both months included. One of thefe was
from fcurvy, the other from afthma. She
was in that time upon two cruifes, each of
which laited eight weeks. During the firft,
the weather was dry and line, and during
the other it was wet and fultry, with the
fame efieti upon health as in the Prudent ;
for in the fecond cruife the fcurvy prevailed
to a coniiderable degree, but not at all during

the

JOOK tU DISEASES OF THE FLEET, 1^2, 1$$,

the firft. This difeafe was prevented from
becoming violent or fatal, on either occaiion,
by the great attention of Mr. Anderfon, the
furgeon. He found great benefit from the
effence of malt, when given early in the
complaint, and fome limes having been taken
in a prize, while this difeafe was at the woril,
the feorbutic men were ib much recovered by
the ufe of them, that they were ail able to
return to duty before the fhip arrived in
port.

DECEMBER.

The whole fquadron continued to lye at
Barbadoes, and nothing worth notice occur-
red in it till the arrival of a reinforcement
of eight fhips of the line, under Sir Richard
Hughes, on the 8th of December. This
fquadron had been detached by Lord Howe,
after the relief of Gibraltar, and the action
with the combined fleets on the 20th of
October. It confifted of one mip of 00
guns, one of 80, three of 74, and three of

64-

l6o DISEASES OF THE FLEET, I782. PARTI.

64. They failed from England on the 9th
of September, and from that time till their
arrival at Barbadoes, they had not been in
port, except for ten days that they were at
Madeira, during which time they were fup-
plied with frem meat, fruit, and vegetables ;
and thereby the fcurvy, which had begun to
prevail to a confiderable degree, was almoft
entirely eradicated, and the health of the
men was furprifingly reftored, for fofhort a
time.

When they joined us, however, there was
a good deal of ficknefs on board of them all,
except the Union and Ruby. The former
had been more than three years in commif-
fion, and in that time had never been iickly,
and had now all the advantages of a long-
eflablimed and well-regulated fliip's company.
All the reft had been newly commiffioned
and manned when they left England. The
fuperior health of the Ruby was owing to
her having been manned with the crews of
other mips, fome of which had juft arrived
from the Weft Indies, whereas the others

had

BOOK II. DISEASES OF THE FLEET, 1782. l6l

had been manned chiefly by draughts of
preffed men from guard-lhips, or by raw
volunteers, of whom a great many were
raifed in Ireland about this time. The Bel-
lona and Berwick having been fomewhat
longer in commiffion than the reft, were lefs
fickly.

The following Tables will mew the com-
parative ftate of health of the fquadron for-
merly on the ftation, with that which had
newly arrived from England.

M TABLE,

l62 DISEASES OF THE FLEET, I?82. PART I.

TABLE, (hewing the prevalence of Sick-
nefs and Mortality in the old Squadron, in
December 1782.

D I 5 E A 5 E S.

Fevers -

Fluxes

Scurvy

Ulcers

Other Complaints

X-

^ .£ <-W

^^ °

Z 8 =» 0

r 3*
94
62

General Proportion

«3 0)

•^ -G ,

^0.2

o s-o

.g-.ss

o
71

124

The proportion of the deaths this month
to the whole number of men on board, was
one in 1102. There were $6 lent to the
hofpital, which was one in 18 of all the fick.

TABLE,

BOGJC II. DISEASES OF THE FLEET, I782. 163

TABLE, mewing the prevalence of Sick-
nefs and Mortality in the new Squadron,
in December 1782.

DISEASES.

Proportion of thofe
taken ill in the
Courfe of the
Month.

Proportion of Deaths
in relation to the
Number of Sick.

Fevers «•

' 55

Fluxes -

Scurvy -

107

Ulcers

191

w ^

Other Complaints

54- |

General Proportion

„ 5

. 64

The proportion of the deaths this month
to the whole number of men on board, was
one in 440, in this part of the fquadron.

M 2 There

164 DISEASES OF THE FLEET, 1782. PART R

There were 189 fent to the hofpital, but
the proportion to the whole number of fick
cannot be afcertained, as we do not know
how many were on the lift on the 1 ft of the
month.

The increafe of fevers in the old fquadron
was chiefly owing to their having fpread in
the Nonfuch, and they feemed to partake more
of that kind which originates in jails and
(hips, than of that which is peculiar to the
climate. The body of one of the men who
died of this fever was infpeoTed at the hofpi-
tal, and there was found to be inflammation
and even perforation of the interlines, with-
out any previous lymptom that could lead to
expect fuch an appearance, and this is a cir-
cumftance more likely to happen in the for-
mer fort of fever than the latter.

The increafe of fcurvy was owing to the
numbers that were taken ill of it in the Mag-
nificent on the paflage from Halifax, from
whence (he failed in the beginning of this
month, and joined the fleet at Barbadoes in the
end of it. There was a great deal of ficknefs

BOOK II. DISEASES OF THE FLEET, 1782. 165

in this fhip at Halifax, and on the pafTage,
owing to the want of fuch clothing as was
fuitable to that fevere climate. One of the
principal complaints was an inflammatory fore
throat.

There was no change in the fituation of
the fleet, only that four mips of the line were
fent on the 16th to cruife near Guadaloupe,
and they continued at fea till the beginning
of February.

The new fquadron was much afflicted with
the jail fever brought from England, and it
was much more prevalent, as well as malig-
nant, on board of the Suffolk than any of
the reft. During the paffage it prevailed moft
in the Princefs Amelia, no lefs than twenty
having died of it. It fubfided in this fhip be-
fore fhe arrived in the Weft Indies, but on
board of the Suffolk it continued to rage
for fome months after.

As the hofpital at Barbadoes wras too fmall

tp contain all the fick of this fquadron, only

the cafes of greateft danger and the molt in-

M 3 fectious

l66 DISEASES OF THE FLEET, 1782. PART I.

fe&ious were fent on fhore, and thofe that
remained were provided with frefri vegetahles
and milk on board of their own fhips, in the
fame manner as had been formerly pradlifed
with fuch fuccefs on fimilar occafions. This
was continued for four weeks, during which
time they all got into tolerable health, ex*
cept the Suffolk.

There appeared, by the returns of the new
fquadron, to be a greater number under the
head of " Other Complaints," which was.
owing to the number of pulmonic complaints,
the confequence of the influenza which pre-
vailed in Europe, at fea, as well as on fhore,
in the fpring and beginning of the fummer
©f this year.

Though inflammatory complaints are rare
in this climate, yet in a few^ of the mips
there was fome appearance of them ; and I
remarked that they occurred in thcfe mips
which were in other refpeets moll: healthy,
and moft free from infection. A good many
of the men were feized with inflammatory
fore throats in the Bellona, a few days before

BOOK II. DISEASES OF THE FLEET, I782. 167

fhe arrived at Barbadoes, and this was in
other refpeets the moil; healthy fhip, next to
the Union and Ruby. In the Union there
was no violent acute complaint whatever,
which was very lingular among fo great a
body of men ; but feveral rheumatifms,
coughs, and catarrhs arofe in her this month,
and there even occurred two pleurifies in the
following month. The bowel complaints
which occurred on board of this fhip were
alfo of an inflammatory nature. Thefe dif-
tempers feemed to proceed from accidental
expofure and irregularity, and is it not highly
probable that thefe caufes, inftead of produ-
cing local inflammatory complaints, might
have been the means of exciting bad fevers
and fluxes, as in the other fhips, had the
men been equally predifpofed to them, by
living in foul air, or under the influence of
infection ?

The following Tables will mew the com-
parative ftate of health of the two fquadrons
in the three firft. months of next year.

M 4 TABLE,

l68 DISEASES OF THE FLEET, 1783. PART I»

TABLE, mewing the prevalence of Sick-
nefs and Mortality in the old Squadron in
January 1783.

DISEASES.

Fevers -
Fluxes - - -
Scurvy - - -
Ulcers - - -
Other Complaints

~ C
""K "* tj-.
°_ o
c rs

■a ev2 ~

o *->

S-l

D O

J2 <u <u

rt «-> '«

0.2 t

£ .J

t *- 5 u

o
£4

c
o ^
•r, <u

General Proportion

lS7

i2i

r 7

117

214

The mortality this month, in relation to
the whole number on board, was one in
1257. About one-rfifteenth of all the fick
were fent to the hofpital.

TABLE,

BOOK II. . DISEASES OF THli FLEET, 1 783. 169

TA BLE, (hewing the prevalence of Sick-
nefs and Mortality in the new Squadron in
January 1783.

DISEASES.

Proportion of thofe
taken ill in the
Courfe of the
Month.

Proportion of Deaths
in relation to the
Numbers of the
Sick.

Fevers -

r 12

' .48

Fluxes -

l53

Scurvy -

320

Ulcers -

'37

Other Complaints

General Proportion

L. si

w 109

The proportion of deaths to the whole
number on board, was one in 540. About
one in thirty of all the Cick were fent to
the hofpital.

TABLE,

17© DISEASES OF THE FLEET, 1783. . PART I.

TABLE, mewing the prevalence of Sick-
nefs and Mortality in the old Squadron in
February 1783.

DISEASES.

Fevers

Fluxes ■■ -

Scurvy

Ulcers

Other Complaints

General Proportion

.c -a

O "S 4-1

^5 °

*j u g g
O

S-.

100
51

I 13!

01 jj «j

O Uj

M O

0.0 2

e *-> <u

I36

L 173

The proportion of deaths to the whole
number on board was one in 1697. One-
ninth of all the fick were fent to the hof-

pital.

TABLE,

BOOK II. DISEASES OF THE FLEET, 1783. 171

TABLE, mewing the prevalence of Sick-
nefs and Mortality in the new Squadron in
February 1783.

^ JC JG
° *j «-»

aths
the
the

*> «

~ a

.^ •" V4H

t— 1 *-• 0

O— O

0 X fi

DISEASES.

C '" If, -^

i-H k^ 3 O

0 « 0 5

ortion
relati(
umber
ck.

§«.£££

PLh

Fevers -

' 3°

r 5°

Fluxes

Scurvy -

212

Ulcers -

i/4

Other Complaints

General Proportion

: lI

. 185

The proportion of deaths to the whole
number, was one in 1276. The proportion
fent to the hofpital was the fame this month
as in the other part of the fquadron.

TABLE,

I?2 DISEASES OF THE FLEET, 1783. PART 1.

TABLE, mewing the prevalence of Sick-
nefs and Mortality in the old Squadron in
March 1783.

;■

DISEASES.

Proportion of thofe
taken ill in the
courfe of the
Month.

Proportion of deaths
in relation to the
Numbers of the
Sick.

- ■

Fevers

■

' 23

I2|

Fluxes -

Scurvy -•-.■-

Ulcers -

,26

Other Complaints

General Proportion

1
1

I U

.194

The proportion of deaths to the whole
number was one in 1361. About one-ninth
of all the lick were fent to the hofpital.

TABLE,

BOOK IX.

DISEASES OF THE FLEET, 1783. 1 73

TA BLE, (hewing the prevalence of Sick-
nefs and Mortality in the new Squadron iti
March 1783.

DISEASES.

Proportion of thofe
taken ill in the
courfe of the
Month.

Proportion of Deaths
in relation to the
Numbers of the
Sick.

Fevers - - -
Fluxes - -
Scurvy - - -
Ulcers - - -
Other Complaints

%
0

49
123

183
38

. 12

O
O

I38

- 403

General Proportion

The proportion of deaths to the whole
number, was one in 4087. About one lit
eleven of all the iick were fent to the hofpi-
tal.

The

fj4 DISEASES OF THE FLEET, I783. PART I.

The main body of the fleet remained at
Barbadoes till the 12th of January, when
they went to cruife to windward of Marti-
nico in order to intercept a French fquadron
expected from North America. This cruife
lafted four weeks ; and intelligence being
received of the enemy's having taken a dif-
ferent" route, the whole fleet bore away for
St. Lucia, where it came to an anchor on
the 8th of February.

In the courfe of the three months above
mentioned, we fee the two fquadrons ap-
proaching to each other in point of health,
till they became pretty equal and fimilar ;
and the new fquadron became even fome-
what more healthy than the old.

The increafe of fevers in the old fquadron
was owing to two caufes. One was the im-
portation of new-raifed recruits brought
from England by fome mips that arrived in
the beginning of January. Thefe were dis-
tributed to fuch fhips as flood molt in need
of men ; and being very dirty and ill cloath-
cd, were likely to harbour infection. They

were

JSOOK II. DISEASES OF THE FLEET, I783. I75

were evidently the ca;«fe of ficknefs in the
Warrior and Royal Oak ; for thefe (hips
were before that time healthy, and the fever
began with thefe Grangers, and fpread
amongft the former crew. It is remarkable
that the fhips that brought them from Eng-
land were not affected by them.

It was caught in the Royal Oak from fix
men that came from England in the Anfon,
which men, though firft put on board the
Namur, communicated no fever there, ha-
ving been kept feparate from the reft of the
men ; but being fent to the Royal Oak,
they were themfelves firft taken ill with a
fever, which afterwards fpread to about
thirty of the other men. What was fingular
in this fever was, that the eyes and fkin of
all that were affected by it became yellow,
though without any particular malignancy,
for only two died on board, and one in the
hofpital. There was one whofe ikin was
very yellow, yet his complaint was fo flight
as never to confine him to his bed.

I The

I76 DISEASES OF THE FLEET, 1 783. PART .

The other caufe of the increafed pro-
portion of fevers in the old fquadron was,
the great number of thefe complaints that
arofe in the Magnificent. This fhip ha-
ving been {ent on a cruife about the
middle of February, and the weather be-
ing rainy, fqually, and uncommonly cold,
for the climate, many fevers of the inflam-
matory kind appeared. During this cruife
me made prize of a large French frigate,
called the Concord, and the greater part of
the prifoners being taken on board, the fever
from that time afTumed a different type,
with new and uncommon fymptoms ; for*
inftead of being inflammatory and requiring
bleeding, as before, it became more of a
low, putrid kind, and was attended in moft
cafes, if not in all, with a continual fweat-
ing ; fo that, inftead of evacuations, the re-
medies that were found moll effectual were
the Peruvian bark, blifters, and opium.
Thus we fee fevers varioufly modified ac-
cording to men's conftitutions, the ftate of
the air, and the noxious effluvia of the
Grangers that intermix with them.

SOOK II. DISEASES OF THE FLEET, 1783. I?7

We find the proportion of fluxes increa-
fing in the new fquadron in January and
February, as they had formerly done in moll:
of the mips foon after their arrival from
England. They were obferved alfo to pre-
vail principally in thofe mips that had for-
merly been mofr. fubjecl: to fevers, and not
to arife till the fever had fubfided. They
were found, for in fiance, to arife later in
the Suffolk, where the fever was obftinate
and malignant, than in the Princefs Ame-
lia, where the fever had been at one time
general and fatal, but not fo violent and lad-
ing as in the other.

The four mips that were fent to cruife
near Guadaloupe continued at fea for feven
weeks ; and it was owing to the prevalence
of fcurvy in thefe and in the Magnificent,
that the proportion of that difeafe was
greater at this time in the old than in the
new fquadron.

The fleet remained at St. Lucia till the
accounts of the peace arrived in the begin-
ning of April. The fervice was then at

N an

I78 DISEASES OF THE FLEET, 1783. PART I.

an end, and I returned to England with
the firit divifion of the fleet, which failed
from St. Lucia on the 12th of April, un-
der the command of Rear-admiral Sir Fran-
cis Drake, who was at this time in ex-
tremely bad health, and requefted me to
accompany him.

PART

t J79 1

PART L

BOOK III.

Of the Numbers and Mortality of different
Difeafes fent to Hofpitals.

CHAP, h

Hofpital at Gibraltar, 1780; — at Barbadoes, 1780-*-
from various Difeafes — Accidents — the Hurricane —
Wounds — Amputations — Scorches — Caufe of Mor-
tality — Fluxes very apt to arife at the Hofpital —
Proportion that were received and died at Antigua -*-
St. Chriftopher's — St. Lucia, and at Barbadoes, 1782—
at Jamaica 1782 — at New York, Autumn 1780 —
1782 — General View of the Admiffions and Mortality
at all the Hofpitals during the War.

XN order to judge of the lofs fuftained by
difeafe, in the courfe of the fervice that has
been related, the fick fent to the hofpitals
muft be taken into account. I fhall, there-
fore, give a fhort view of the different difeafes
admitted, and their mortality, at the feveral
hofpitals connected with the fleets in which
I ferved. This will ferve alfo to illuftrate
N 2, the

I'OO ACCOUNT OF PART U

the different effects that different fituations
have upon the health and recovery of men*.

The fleet which effected the firfl relief of
Gibraltar, under the command of Lord
Rodney, confuting of twenty (hips of the
line, arrived there in the third week of Ja-
nuary, 1780, after a paffage of three weeks
and a few days from England, in which.
they had an action with the Spanifh fleet y
and obtained a victory over them on the 1 6th
of that month. The whole fleet, except
one fhip, failed from Gibraltar on the 13th
of February, and while it lay there, the
difeafes fent to the hofpital, and their re-
fpective mortality, were as follows f :

Fevers

* As my own flay at different ports was fhort, and as
my own knowledge could not extend beyond that period,
Dr. Farquarfon, Firfl Commiffioner of the fick and
wounded Seamen, very politely gave me leave to infpecl:
the ftooks of the different hofpitals at his office, and I
collected from them the fate of all the men that were-
Tanded,

...+-It is proper to mention, that the name of the difeafe
m the hofpital books being taken from the ticket fent

* '-' an

230 OK II I*

THE HOSPITALS*

13 1

DISEASES.

Admit-
ted.

Died.

Propor
tion.

Fevers -
Fluxes -
Scurvy -
Ulcers -
Wounds - -
Other Complaints

622

29
12

3
9
3

M
O -

7
4 j

* 9

Total - -

ll3

*This comprehends not only the deaths
in the time the fleet remained there, but all

on fliore with each fick perfon, great accuracy is not to
be expected, as this is frequently done in a carelefs man-
ner. My returns were made with great exadtnefs; and,
in the latter part of the war, the hofpital books may alfo
be depended upon in this refpedr, the tickets, at my re*
queft, having been made out with accuracy.

* In this, and the other tables, the fmalier fractions
?re neglected.

N 3 that

l82 ACCOUNT OF PARTI*

that happened afterwards. The mortality
from wounds and ulcers is greater than
might be expected in fo fine a climate, and
at the coolefl feafon of the year ; but as the
place was then befieged, the fick and wound-
ed could not be fupplied with thofe refrefh-
ments that were neeefTary to the recovery of
the men, and wounds and ulcers are com*
plaints very apt to be affected by the qua*
lity of the diet.

The

BOOK III.

THE HOSPITALS.

The following is an Account of the Men
admitted at the Hofpital at Barbadoes in the
campaign of 1780, that is, from the 16th of
March till the end of June.

DISEASES.

Admit-
ted.

Died.

Propor-
tion.

Fevers - - - -
Fluxes - - - -
Scurvy - - -
Ulcers -
Wounds - - -
Other Complaints -

277

7°
199

167 .
129

47
16

61
23

' 6}
4
4
Si

- 41

Total -

943

212

The fevers were chiefly from the five line

of battle mips that came immediately from

Europe in March. Upon their arrival, they

fent on fiiore 193 men ill of fevers, only

N 4 ojoe

184 ACCOUNT OF PART J.

one with the flux, 1 5 with the fcurvy, and
five with ulcers.

When thefe fhips returned to Barbadoes,
in May, along with the reft, of the fleet,
the greater part of the.fick were then alio,
on board of them. By that time the flux
and fcurvy had broke out. The former pre-
vailed chiefly in the Terrible, the latter in
the Intrepid. That part of the fleet which
we found on the ftation fent on more a very
fmall proportion of all the claries of com-
plaints, except wounds.

Of the wounds, nineteen were amputa-
tions, of which there died nine, moftly of
the locked jaw. There were 46 fcorched by
gunpowder, of whom there died 14; fa
that, befides thofe who were killed outright,
and thofe who died on board in confequence
of accidents of this kind, before they could
be fent to an hofpital, about one fourth of
all the wounds, and the fame proportion of
all the deaths from wounds, at the hofpital,
was owing to this caufe. This circumftance

ought

BOOK Illi THE HOSPITALS. 185

ought to induce commanders to take every
precaution to prevent fuch accidents. In the
fubfequent part of the war they were lefs
frequent in confequence of the greater cau-
tion, and method acquired by practice and
experience %

In the account of the mortality I have in-
cluded only fuch as died before the ift of
January, 1781 ; for if any were carried off
after that time, it was moft probably by fome
incidental complaint. There were 65 of
them at that time remaining, and they were
chiefly men difabled by lamenefs waiting
for a pavTage to England as invalids.

Out of the 23 that were killed by the fall
of the houfe in the hurricane on the 10th
of October, eight were of the number above
accounted for ; but thefe are not included in
any of the clafles of deaths.

The mortality among the men admitted
at this time was greater than what occurred

f See the laft chapter of Part III.

after-

*86 ACCOUNT OF PARTI.

afterwards in any of the hofpitals that I at-
tended, except that at Jamaica. The princi-
pal caufe of this was, that as the fleet was
fo much greater than had ever been known
here before, there was not a fuitable accom-
modation for fuch numbers as it was necef-
lary to fend on fhore, and we had not then
fallen on the method of fupplying refrefh-
ments to the men on board of their lhips.
The circumftance by which the men fuffer-
ed moft was, the great crowding which the
want of room made neceflary. There is
here no public building appropriated for an
hofpital ; fo that this, as well as every thing
elfe, being found by contract, and the num-
ber of lick being fo much greater than it
was ufual to provide for, the whole was at
this time conducted in a manner not very
regular.

It appears that the greateft mortality in
any clafs of difeafe was that of the fluxes,
of which the greateft number Cent to hofpi-
tals are fuch as have languished for fome
time under this difeafe, in which ftate it ge-
nerally

BOOK III. THE HOSPITALS. 187

nerally proves fatal in the Well: Indies, in
confequence of incurable ulcers in the great
inteftines, to which the heat of the climate,
as well as the fcorbutic habit and fea diet, is
particularly unfavourable. But the whole
of the mifchief arifing from it does not ap-
pear in the table ; for it was the mod apt of
any difeafe to fupervene upon other com-
plaints which were under cure at the liofpi-
Lai. It more particularly attacked thofe
who were recovering from the fcurvy, and
was the caufe of the greater number of
deaths under this head in the table. It was
found to be more contagious than fevers,
either becaufe the men's conftitutions were
more predifpofed to it, or, perhaps, becaufe
the infectious matter of it being more grofs
and lefs volatile, it is not fo readily diflipated
by the heat of the climate ; for, either from
this, or fome other circumftance, infectious
fevers are not fo eafily generated, nor fo apt
to fpread, as in Europe. That thefe fluxes
were owing to infection, may he inferred
from hence, that, when men ill of the
fcurvy were cured on board of the mips

they

*$& -ACCOUNT. OF FART I*

they belonged to, they were not liable to
this difeafe, neither did they prevail at thefe
hofp'itals afterwards, when great care was
taken to feparate infectious difeafes from the
others.

The only regular hofpital on this itation
is that at Antigua. This ifland being the
feat of the royal dock yard, there is anefta-
blifhed hofpital in time of peace as well as
war. It fo happened that great fleets never
came here to put their fick and wounded on
fhore, as at Barbadoes ; fo that the greater
number of thofe received into it were from
fingle fhips that came to careen. As there
was, therefore, lefs neceflity for crowding,
and as the (lighter cafes could be admitted,
there was a lefs proportion of deaths here,
than at moft of the other hofpitals.

There were two other ejftablifhments for
the reception of the fick and wounded on this
ftation,- but they were only temporary,
Thefe were at St. Lucia and St. Chriftopher's,
where the men being received in great num-
bers

100k III. THE HOSPITALS. 189

bers at a time from large fleets, and as there
were accommodations only for the moft ur-
gent cafes, the mortality approached more
nearly to that of Barbadoes. There died at
St. Chriftopher's, in the years 1780 and
1 78 1, in the proportion of one in fix, and
at St. Lucia, in the fame time, one in 5! or
two in 11. The air of the hofpital at St.
JLucia was remarkably pure, and this degree
of mortality was owing to the fick having
been accommodated in tents and huts. In
the two laft years of the war, when an hof-
pital was built, and regularly eftablimed, the
mortality was not much above one half of
this.

Some authors have endeavoured to form
an eftimate of the fuccefs of practice from
the different rates of mortality. But this is
extremely fallacious ; for the fatality of dif-
eafes will depend on their violence, the pro*
portion of deaths being very different in cafes
that are flight, from what it is in thofe that
are dangerous. We fhall take a view, how-
ever^ of the hofpital at Barbadoes at another
1 period,

IQO ACCOUNT OF PART I*

period, in which there feemed little or no
difference in the violence of the difeafe, and
when the fuperior fuccefs feemed to be ow-
ing to the hofpital's not being fo crowded,
and to the better attendance and treatment of
the fick. The following is a view of the
difeafes that were admitted in the laft three
months of the year 1782, the greater part
of which were landed from the reinforce-
ment of eight mips of the line that joined
the fleet at Barbadoes, in the beginning of
December :

Fevers

book iiir.

THE HOSPITALS.

191

DISEASES.

Admit-
ted.

Died.

Propor-
tion.

Fevers -

224

' 8

Fluxes -

t: 3

Scurvy

5°

'10

Ulcers -

■ 25

. 2*

Other, Complaints

Total - -

362

It happened on this, as on the former oc-
casion, that none were fent on more hut
fuch as were very ill, or had contagious
complaints, the reft being provided with re-
freshments on board of their fhips. There
were no wounds at this time, but there was
a greater proportion of fevers, fo that the
complaints, upon the whole, might be faid
to be about equally dangerous. The morta-
lity now was, however, considerably lefs, and
this is to be imputed to the more favourable
Situation of the hofpital, which I did not
allow to be over crowded ; and the men had

every

iq?

ACCOUNT OP

PAP.T U

every juflice done them in point of atten-
dance and accommodation.

I mall give another example of the fame
kind in the hofpital at Jamaica, when our
fleet went there after the battle of the 12th
of April. All the men accounted for here
were landed from the fleet under Lord Rod-
ney in May, June, and July, 1782 *.

DISEASES.

Admit-
ted.

Died.

Propor-
tion.

Fevers -
Fluxes -
Scurvy -
Ulcers -
Wounds - - -
Other Complaints

224

65
48

'70
40

18
18

■g

J-

3
5

4
4
2

l3i

Total - -

539

161

This

* In the year 1 741, the fleet under Admiral Vernon
was at Jamaica at the fame time of the year ; and the fol-
lowing

SSOOK III,

THE HOSPITALS.

*93

This uncommon degree of mortality was
not owing to the bad air of the place, for
Port Royal is naturally as healthy as moil
parts in that climate ; nor was it owing to
bad accommodations, or to neglect of any
kind; but is imputable entirely to this cir-

lowing is the account of the men fent to the hofpital i
May and June :

DISEASES.

Admit-
ted.

Died.

Propor-
tion.

Fevers -
Fluxes -

Other Complaints - -

957
267

167

255
73
41
26

c
a ■

; si

7.3

t 4

Total - - -

1703

395

There were on board of this fleet about two-thirds of
the number of men that was on board of the fleet of 1 782.
I cannot afcertain how many died on board of the {hips in
Admiral Vernon's fleet, but the deaths at the hofpital
alone are fomewhat more than what happened to our fleet
both on board and at the hofpital.

O cumftanee,

194 ACCOUNT OF « PAKT !^

cumftance, that the hofpital being extremely
fmall, thofe only were fent to it who were
very ill. There were at this time upwards
of forty mips of the line at Jamaica, and an
hofpital, containing only 300 beds, could
afford but a very inadequate relief. Some
officers are unwilling that any man mould
die on board of their mips, for fear of difpi-
riting the others, and many were fent to the
hofpital, in the moft defperate ftage of fick-
nefs, that they might there die.

There cannot be a iTronger proof than
this of the fallacy of judging of the fuccefs
of practice by the proportion of the deaths ;
for the fick on this occafion were better ac-
commodated, better provided for in every
refpect, and as regularly attended, as at any
other period of my fervice in the Weft In-
dies, yet the mortality was greater than at
any other time.

Having given inftances of the common

rate of mortality in hofpitals in Europe and

the Weft Indies, I mall next give examples

of the fuccefs we had in North America,

2 when

BOOK III. THE HOSPITALS. 1$$

when the fleet was there in the autumns of
1780 and 1782.

ACCOUNT of the Sick landed at New
York from the Weft-India Fleet, confirm-
ing of eleven Ships of the Line, in Au-
tumn, 1780.

DISEASES.

Admit-
ted.

Died.

Propor-
tion.

Fevers - -

' 4

Fluxes

229

Scurvy -

433

'Z 1 ll

Ulcers - - -

V 6

Other Complaints

- 9

Total - -

825

O 2

ACCOUNT

J96 account of fart i.

ACCOUNT of the Sick landed at -New
York from the Weft-India Fleet, confining
of twenty-fix Ships of the Line, in Au-
tumn, 1782.

DISEASES.

Admit-
ted.

Died.

Propor-
tion.

. Fevers - - -

104

Fluxes -

'31

1.4

Scurvy -

617

3°

Ulcers -«

Other Complaints

7°

Total - -

996

L x4

The difference of mortality here from
what occurred in the Wefr. Indies, is partly
imputable to climate, and partly to the
fmaller number of acute difeafes ; and in
the two accounts before ftated the difference
in favour of the latter feemed chiefly to arife
from the fuperior attention and better treat-
ment

BOOK III. THE HOSPITALS, I97

meat of the fick. It was mentioned before,
that in autumn, 1782, at New York, they
were better fupplied both at hofpitals, and
on board of their fhips, with every thing
that could be wifhed, and that on this occa-
sion almofl: every fcheme I had propofed was
realifed. The extraordinary fuccefs in the
fcurvy was owing to the great quantities of
vegetables that were fupplied ; for feyeral
fields of cabbages had been planted in the
neighbourhood of the hofpital for the ufe of
the fick. This was owing to the humane
attention of Admiral Digby, who had alfo
caufed cows to be purchafed to fupply the
hofpital with milk. Cleanlinefs, and the fe-
paration of difeafes, were alfo firiclly attend-
ed to ; and I am perfuaded that many of the
fcorbutic men were faved by keeping them
feparated from the fevers and fluxes ; for it
has been obferved, that men with the fcurvy
or recovering from it, are very apt to be in-
fected, particularly with the flux.

It appears, that the difeafe in which cli-
mate makes the greateft difference, is the flux.
It was obfervable, that though the dyfen-
£erv at this time was more fatal on board
O 3 of

I98 ACCOUNT OF PARTI.

of the fhips at New York than in the Weft
Indies, yet they were lefs fo at the hofpital.
The caufe of this feems to be, that the
acute ftate of this difeafe, of which men die
on board before there is time to remove them
to an hofpital, is more fatal in- a cold cli-
mate ; but when it becomes more pro-
tracted, which is the cafe with moft of the
cafes fent to hofpitals, they then do much
better in fuch a climate.

I mail here fubjoin an account of the
numbers that were admitted, and died, du-
ring the whole war, at the hofpitals of the
different parts at which the fleets I was
connected with touched.

BOOK III. THE HOSPITALS.

199

Admitted.

Died.

Propor-
tion.

At Gibraltar - -

2131

203

'■ IO

Barbadoes - - !

4604

861

'Pi

Antigua

6099

914

St. Lucia - -
St. Chriftopher's

3363
*53

478

142

7
6

Jamaica

10088

1672

New York - -

17880

2179

. 7

Total - -

45018

6449

I have been able to calculate the numbers
of deaths from difeafe in this great fleet, both
on board and at hofpitals, during the period
of my own fervice, which was three years"
and three months, and they amounted to
3200*, independent of thofe that were
killed and died of wounds.

There

* I was enabled, after coming to England, to afcertain
the deaths in that part of the fquadron from which I hap-

O 4 pened

SOd ACCOUNT OF PARTI.

There died of difeafe in the fleet I be-
longed to, from July, 1780, to July, 1781,
about one man in eight, including both
thofe who died on board and at hofpitals *..
But the annual mortality in the Weft-India
fleet, during the lair, year of the war, that
is, from March, 1782, to March, 1783,
was not quite one in twenty -f. This diffe-
rence was partly owing to the general in-
creafe of health in fleets as a war advances^
partly to fome improvements in victualling,
and partly to better accommodations as well
as regulations in what related to the care of

the flick*

Though

pened at any time to be abfenr, by having leave from the
Navy Board to infpecl: the fhips books depofited at their
office.

* See Appendix to Part II.

f The mortality of the army in the Weft Indies is
much greater ; for it appears by the returns of the War
Office, that there died in the year 1780, 2036 foldiers,
which being calculated by the numbers on the ftation,
and thofe who arrived in the convoy in March and July,
the annual mortality is found to be one in four. The
greatnefs of this mortality will appear in a flill flronger
light when it is confidered that thofe who ferve in the
army are the moft healthy part of the community.

When,

BOOK I lit THE HOSPITALS* 201

Though the mortality in fleets in the
Weil Indies is upon the whole greater than
in Europe, yet it has fo happened, that, in
the late war, the fleet at home has, at par-
ticular periods, been conflderably more
fickly than that in the Weft Indies was at
any one time. I was informed by Dr. Lind,
that when the grand fleet arrived at Ports-
mouth in November, 1779? a tenth part of
all the men were fent to the hofpital. It
appears*, that in the years 1780 and 1781,
a period at which the fleet in the Weft In-
dies was moft fickly, the medium of the
numbers on the fick lift was one in fifteen,
and many of thefe were very flight corn-
When I was at the encampment at Coxheath in the year
1779, I was politely favoured with a fight of the returns,
both of the general officers and phyfician, and it appeared
that in an army of 10,089 men, there died, from the 10th
of June to the 2d of November, forty-three, exclufive of
twelve who died of fmall-pox. This being calculated,
is equal to an annual mortality of one in 109; and it
was not half fo much in the encampment of the former
year. It appears by Mr. Simpfon's tables, that the mor-
tality of mankind in England, from the age of twenty to
forty-five, which includes the ufual age of thofe whe»
ferve in the navy and army, is one in fifty.
* See Table II

plaints ;

204 ACCOUNT OP PARTI.

plaints ; whereas, in the fleet alluded to in
England,, the difeafes were moitly fevers,
and fo ill as actually to be fent to the hof-
pitaL It appears likewife that there was the
greateft proportion of fick in our fleet when
it was on the coafr. of America in September,
1780*. This difference is owing to the
greater prevalence of the fhip fever and of
the fcurvy in a cold than in a hot climate.

With regard to the mortality at hofpitals,
the comparifon is greatly in favour of thofe
in England f. This is owing to the greater
regularity, and the better accommodation
arid diet which an hofpital at home admits
of, as well as to the advantage of climate. It
has alfo been mentioned, that, on moft oc-
cafionSj the hofpitals I attended abroad were
fo limited as to contain only the worft cafes,
in eonfecjuence of which there would of
eourfe be a greater proportional mortality
than in the great hofpitals of England.

* See Table II.

f When I was at Haflar in 1779, Dr. John Lind po-
litely favoured me with an account of the mortality at
that hofpkal, and it appeared that there died only one in
thirty of the whole that were admitted, and one in fe-
vsnteen or eighteen of the fevers*

The

BOOK III. THE HOSPITALS. SOJ

The following is an account of the whole
lofs of lives from difeafe, and by the ene-
my *, in three years and three months, in
the fleets and hofpitals with which I was
connected :

Died of difeafe f - 3200
Killed in battle - 648

Died of wounds - 500

Total § - 4348

* None are comprehended but thofe who were killed
or wounded in battles in which the whole fleet was pre-
fent, this account not including thofe who fell in ftngle
a&ions in frigates or other ihips.

f It would appear that, anciently, though the (laugh-
ter in battle was greater than in modern times, yet that
difeafe was ftill more deftru£tive than the fword. One
of the oldeft testimonies to this purpofe is in the Hiftory
of Alexander's Expedition, by Arrian — rovs /ai> bv t«%

fxck-^ouc, ctfroXuhvtxffui} ot os £* mm Tgav//.«Twv «7ro/xap£oi yeyei/Y)iAevot^

01 7jv\stou? h voau a7roXuteaa.11. — - Arrian. Hift. Alex. Exped.

Lib. v. cap. 26.

§ Upwards of three thoufand were alfo loft at fea in mips
of war belonging to the fame fleets in the hurricane of
October 1780, and in the ftorm in September 1782, in
which the Ville de Paris and the ®ther French prizes were
loft on their paflage to England.

It muft for ever remain unknown from what particular
accidents fo many mips foundered at this time. But there
is great reafon to fufpect, that though the fheathing with

copper

204 ACCOUNT GF THE HOSPITALS. PART I*

copper tends to preferve fhips for a length of time, fo as to
prevent the necefEty of frequent careening, and has alfo
the effect of preferving the bottom fmo©th and clean, fo
as to make them fail the fafter; yet copper having the
power of corroding, and in time entirely deftroying every
thing made of iron that may be near it, the frames of the
French ihips, which are built by faftening the planks of
the fides with iron fpikes, come thereby to b© loofened;
and the Ville de Paris, the Glorieux, and Centaur, which
were loft at this time, were copper bottomed, and of French
construction. Englifh fhips are not fubject to this incon-
venience, as wooden nails, or tree-nails, as they are called,
are made ufe of in building them ;, yet there is reafon to
think, that the iheets of copper conceal defects in the
wood, fo that large leaks may appear on a fudden, upon
the copper's giving way. The Thunderer and Ramillies,
two other ihips that foundered, were of Englifh conftruc-
tion. But this method of fitting fhips, though extreme-
ly ufeful in many refpects, and by its being general in
our navy, gave us great advantages over the enemy in
the late war, yet it is attended with fome inconveniences
and great expence ; and it will probably hereafter be ren-
dered unneceflary, by a very late inveution of extracting
tar from coal, which, from its fingular power of preferving
the bottoms of ihips, is likely to turn out one of the moil
valuable acquifitions to the art of navigation, fince the
cl'ifcovery of the eprnpafs. This method of making mine-
ral tar was fir ft found out and practifed by the Earl of
Dundonald, who has fo fuccefsfully employed his happy
genius and great ikill in chemiftry upon objects of public
utility ; and this, as well as other important discoveries
in the fame branch of fcience, are equally honourable to
lumfelf and beneficial to mankind,,

PART

C 2°5 1

P A R T II.

OF TH E

CAUSES of SICKNESS in FLEETS,

AND THt

MEANS of PREVENTION.

INTRODUCTION.

IN the year 1780 I printed a fmall trea-
tife for the ufe of the fleet, containing ge-
neral rules for the prevention of rlcknefs,
and this part of the work is chiefly taken
from it.

My own opportunities of experience,
as exhibited in the preceding Part, have
been fufficiently extensive to fuggeft many
obfervations on this fubject ; but as my ob-
ject is utility rather than the praife of ori-
ginality, I mail not confine myfelf to thefe.

Great

206 CAUSES AND PREVENTION PART IT.

Great part of what is to be advanced is
taken from books* and converfation, as
well as my own experience, my defign be-
ing to exhibit a concife view of all the dis-
coveries on this fubject that have come to
my knowledge. I have aflumed nothing,
however, from mere report or teflimony,
having had opportunities from my own ob-
fervations of verifying or difproving the
aiiertions of others.

More may be done towards the preferva*
tion of the health and lives of feamen than
is commonly imagined ; and it is a matter
not only of humanity and duty, but of in-
terest, and policy.

Towards the forming of a feaman, a fort
of education is neceffary, con'fifting in an
habitual practice in the exercife of his pro-
feffion from an early period of life ; fo that

* The authors from whom I have borrowed have been
chiefly Dr. LLnd and Capt. Cook. To the former we
are indebted for the rnoft accurate obfervations on the

health.

SECT. I. OF DISEASES. 20|

if our flock of mariners mould come to be
exhaufted or diminimed, this would be a
lofs that could not be repaired by the moft
flourifhing frate of the public finances ; for
money would avail nothing to the public
defence without a fufficient number of able
and healthy men, which are the real re-
sources of a ftate, and the true finews of
war.

In this view, as well as from the peculiar
dependence of Britain on her navy, this or-
der of men is truly inefrimable ; and even ""
considering men merely as a commodity, it
could be made evident hi an ^economical and
political view, independent of moral consi-
derations, that the lives and health of men
might be preferved at much lefs expence
and trouble than what are neceffary to re-
pair the ravages of difeafe.

health of feamen in hot climates ; of the improvements
made by the latter, an excellent compendium may be leeii
in Sir John Pringle's Difcourfe before the Royal So-
ciety on theoccafion of adjudging a prize medal to Capt.
Cook for his paper upon this fubje£r.

208 CAUSES AND PREVENTION' PAR? If,

It would be endlefs to enumerate the ac-
counts furnifhed by hiftory of the lorTes and
difappointments to the public fervice from
the prevalence of difeafe in fleets. Sir
Richard Hawkins, who lived in the begin-
ning of the laft. century, mentions, that in
twenty years he had known of ten thoufand
men who had perifhed by the fcurvy.
Commodore Anfon, in the courfe of his
voyage of circumnavigation, loft more than
four fifths of his men chiefly by that dif-
eafe. Hiflory fupplies us with many in-
ftances of naval expeditions that have been
entirely fruflrated by the force of difeafe
alone : that under Count Mansfeldt in 1624;
that under the Duke of Buckingham the
year after ; that under Sir Francis Whee-
ler in 1693 » t^iat to Carthagena in 1741 %
that of the French under D'Anville in 1 746 ;
and that of the fame nation to Louifbourg
in 1757*.

* In the late war ficknefs alone was not the caufe of
want of fuccefs in any inftance, except in the laft action
in the Eafl: Indies, in which fo many men were ill of the
fcurvy, that there were not hands enow to manage he;
gons.

That-

PART II. OF DISEASES. 200,

That the health of a (hip's company de-
pends in a great meafure upon means within
our power, is ffrongly evinced by this, that
different mips in the fame fituation of fer-
vice enjoy very different degrees of health.
Every one who has ferved hi a great fleet
muff have remarked, that out of mips with
the fame complement of men, who have
been the fame length of time at fea, and
have been victualled and watered in the
fame manner, fome are extremely fickly,
while others are free from difeafe. Is it
not naturally to be inferred from hence,
that the health of men at fea depends in a
great meafure upon circumftances within
the power of officers, and indeed upon their
exertions, much more than medical care *:

It has appeared in the preceding part of
this work, that the difeafes moft prevalent

* It is not meant by this to infinuate, that every
commander is abfolutely accountable for the health of
his fhip's company, and cenfurable when they are fickly;
for this may depend on his predeceflbr in command, or a
ftubborn infection may have prevailed from che original
fitting out or manning of the fhip which he may not
"have fuperintended.

P among

2.IO CAUSES AND PREVENTION PUT II.

among fea-men are fevers, fluxes, and the
icurvy. Thefe are indeed fome of the rnoft
fatal that can attack the human body ; but
there is a numerous tribe of complaints,
which are alfo fome of the moft fevere
icourges of human nature, from , which
they are in a manner entirely exempt. —
Thefe are the difeafes to which the indolent
and luxurious are fubjecl:, and which fo far
embitter their life as to render their portion
of worldly enjoyment nearly on a level with
that of the poor and laborious. The dif-
eafes alluded to are chiefly the gout, flomach
complaints, hypochondriac and other ner-
vous diforders. In all countries it is the bet-
ter fort of people that are mod: fubfec"t to
thefe ; for they are owing to the want of
bodily exercife, to the great indulgence of
the fenfes, and a greater keennefs and de-
licacy in the pafiions and fenfiments of the
mind. Man being formed by nature for
active life, it is necefiary to his enjoving
health that s mu/cular powers mould be
exeiciied, and that his fenfes mould be ha-
bituated to a certain ftrength of impreffion.
Animal and vegetable nature may be aptly

enough

PART II. OF DISEASES. 211

enough compared to each other in this re-
flect ; for a tree or plant brought up in a
greater degree of fhelter and made than what
is fuitable to its nature, will be puny and
fickly ; it will neither attain its natural
growth nor ftrength of fibre, nor will it be
able to bear the influence of the. weather,
nor the natural viciffitudes of heat and cold
to which it may be expofed.

It is to be remarked, however, that exer-
cife and temperance may be carried to ex-
cefs, and that in thefe there is a certain fa-
lutarv medium ; for when labour and abfti-
nence amount to hardfhip, they are equally
pernicious as indulgence and indolence.
This is flrongly exemplified in feamen ; for,
in confequence of what they undergo, they
are in general fhort lived, and have their
conftitutions worn out ten years before the
reft of the laborious part of mankind. A
feaman at the age of forty-five, if fhewn to
a perfon not accuilomed to be among them,
would be taken by his looks to be fifty -five,
or even on the borders of fixty.

P 2 The

212 CAUSES AND PREVENTION PART II.

The moil common chronic complaints
which a long courfe of fatigue, expofure to
the weather, and other hardfhips, tend to
bring on, are pulmonary eonfumptions,
rheumatifms, and droplies. It is alfo to be
conlidered, that thefe complaints, particu-
larly the lafr, are farther fomented by hard
drinking, which is a common vice among
this clafs of men, and they are led to in-
dulge in it by the rigorous courfe of duty to
which they are fubject.

With regard to gout, indigeftion, hypo-
chondriac complaints, and low fpirits, there
is fomething in hard labour of every kind
that tends to avert them, and particularly in
that rough mode of it peculiar to a fea life.
There is alfo fomething in the harm fenfa-
tions from the objects which feamen are in
ufe to fee, hear, and handle, which fo mo-
difies their constitutions and hardens their
nerves as to make them little liable to what
may be called the difeafes of exceffive refine-
ment, fuch as thofe above mentioned. I
have, indeed, met with fuch difeafes at
naval hofpitals ; but I always remarked that

they

FART II. OF DISEASES, 213

they were in landfmen who had been prefled,
and who had been bred to fedentary and in-
dolent occupations.

The difeafes above enumerated, as well as
moft other chronic complaints, being the
offspring of indolence and luxury, while
fevers and feverim complaints fall1 equally
on all ranks and defcriptions of men, it
was a faying of fome of the ancients, that
acute difeafes were fent from heaven * ;
whereas chronic difeafes were of man's own
creation. But I mall endeavour in the
courfe of this work to evince, that, with re-

* Wherever caiafes are obfeure, fuperflition naturally
afcribes them to fome preternatural influence ; and what
feemed farther to encourage this anciently, was, that vio-
lent epidemics occurred moft frequently in camps and at
fieges at fome great conjunctures, in which fuperior pow-
ers were fuppofed to intereft themfelves. Thus we read
in Homer of fatal difeafes being fent as punifliments by the
gods. But the peftilential difeafes fo often mentioned by
poets and hiftorians as prevailing in cities and armies, were
probably nothing elfe but fevers produced by corrupted
human effluvia, which was very apt to be produced by
the want of perfonal cleanlinefs, to which the mode of
cloathing among the ancients would more particularly
fubjecT: them, and. efpecially in camps and befieged towns.

P 3 gard

214 CAUSES AND PREVENTION PART II.

gard to feamen at lead, acute difeafes are as
much artificial as any others, being the off-
fpring of mifmanagement and neglect ; with
this difference, that they are imputable not
fo much to the mifconducl of the fufferers
themfelves, as of thole under whofe pro*
tection they are placed.

If I were to add any other complaint to
the three already mentioned, as moil preva-
lent, and peculiar to a fea life, it would be
thofe foul and incurable ulcers which are fo
apt to arife at fea, particularly in a hot cli-
mate. The flighteft. fcratch, or the fmalleft
pimple, more efpecially on the lower extre-
mities, is apt to fpread, and to become an
incurable ulcer, fo as to end in the lofs of a
limb. The nature of the diet, and the ma-
lignant influence of the climate, both con-
fpire in producing them.

The difeafes moir frequent and prevalent
at fea have this advantage, that they are
more the fubjeds of prevention than moft
others, becaufe they depend upon remote
caufes that are affignable, and which increafe

and

PART II. OF DISEASES. aijj

and diminim according to certain circum-
ftances, which are in a great meafu re within
our power.

The prevention of difeafes is an object
as much deferving our attention as their
cure ; for the art of phyfic is at befl but
fallible, and ncknefs, under the beft. medi-
cal management, is productive of great in-
convenience, and is attended with more or
lefs mortality. The means of prevention
are alfo more within our power than thofe
of cure ; for it is more in human art to re-
move contagion, to alter a man's food and
cloathing, to command what exercife he is
to ufe and what air he is to breathe, than it
is to produce any given change in the inter-
nal operations of the body. What we know
concerning prevention is alfo more certain
and fatisfa&ory, in as much as it is eafier to
inveftigate the external caufes that affect
health than to develope the fecret fprings of
the animal oeconomy.

This part of the work, therefore, is

chiefly addreffed to thofe who direct the

P 4 navy

2l6 CAUSES AND PREy ENTION PART IX,

navy either in a civil or military capacity ;
for the general health of mips depends fo
much upon the victualling and manning in
the firft. inftance, and, afterwards, on the
degree of discipline and order which are
kept up, that I am perfuaded that a certain
degree of attention on their part would
almoft entirely eradicate difeafe from our
fleets.

Several remarks in this part of the work
will be found fo obvious, that it might
feem fuperfluous to mention them. But it
has been my intention to omit nothing that
I have heard of or obferved as a matter of
afcertained utility, and, I believe, the moil
experienced will find either fomething new,
or what they had not before fufficiently at-
tended t:o. Though the dellgn of it is that
of being extenfively ufeful, yet my trouble
would be compenfated, fhould it prove the
means of health and comfort to a fingle
{hip's company ; nay, I (hould not repent
my labour, could I enjoy the confcious cer-
tainty of its being the means of faving the
life of one brave and good man.

The

PART II. OF DISEASES, 2IJ

The prevention of difeafes has relation
only to the external caufes that afFec"t health,
and I fhall confider thefe under the four
heads of

I. AIR, III. EXERCISE,

JI. ALIMENT, IV. C LOATH I KG.

CHAP.

2l8 CAUSES AND PREVENTION PART II,

CHAP. I.

A I R.

NDER this head I fhall not only cqn-
fider the natural ftate : the air of the at-
mofphere in point of heat and coid, moifture
and drynefs, purity and corruption, but alfo
the different artificial impregnations of it
from the holds or other parts of a fhip, or
from the peribns of men who have been
neglected in point of cleanlinefs.

The common air of the atmofphere at fea
is purer than on more, which gives to a fea
life a very great advantage over a life at
land. This advantage is flill greater in the
tropical regions, where the land air, efpe-
cially fuch as proceeds from woods and
marines, is fo fatal, and where the heat is
alfo conliderably lefs at fea than on more.
But this fuperior purity of the air at fea is
i more

CHAP. I. OF DISEASES. 219

more than counterbalanced by the artificial
means of propagating difeafes on board of
a fhip. Since a fea life, however, has this
great natural advantage to health, the caufes
of difeafe peculiar to it are chargeable rather
to the mifmanagement of men than to any
thing unavoidable in nature ; and we are
from this encouraged to exert our endea-
vours in removing them.

The effects of land air, however, are not
to be neglected by thofe who are ftudious of
preferving the health of a fhip's company,
for feamen are expofed to it in various ways
while they are in harbour ; and it is what
we fhall firfl treat of ,

SECT.

220 CAUSES AND PREVENTION PART XI.

S E C T. I.

Of the noxious Effects of Land Air in
particular Situations.

ALL the difeafes incident to a fleet, except
the fcurvy, are more apt to arifeina harbour
than at fea, and particularly the violent fevers
peculiar to hot climates. There are generally
woods and marfhes adjacent to the anchoring
places in the Weft Indies, and the men are
expofed to the bad air proceeding from thence,
either in confequence of the fhip's riding to
leeward of them, or of people's going on more
on the duties of wooding and watering. In-
stances of this, without number, might be
adduced from the accounts of voyages to all
the tropical countries. Our fatal expeditions
to the Baflimentos and to Carthagena in for-
mer wars, are Striking proofs of ita and we
have feen the fame effects, though in a much
lefs degree, while the fleet was at Jamaica
in 1782.

I have

SECT.!. OF DISEASES. 221

I have known a hundred yards in a ,road
make a difference in the health of a (hip at
anchor, by her being under the lee of marmes
in one fituation, and not in the other *.
Where people at land are fo fituated, as not
to be expofed to the air of woods and marches,
but onl/jrto the fea air, they are equally heal-
thy as at fea. There was a remarkable in-
flance of this on a fmall ifland, called Pid-
geon Ifland, formerly defcribed, where forty-
men were employed in making a battery, and
they were there from June to December,

which

* If the experiments of modern philofophy are to be
depended on, they go a certain way to account for the
unwholefomenefs of air from woods in hot climates, and
in wet weather; for Dr. Ingenhoufz found that the
effluvia of plants in the night time, and in the fhade, are
more poifonous in hot than in cold weather ; but though
there is a falubrity in the effluvia in funfhine, the heat of
the weather makes no difference with regard to this.
He found alfo that vegetables, when wet, yield an un-
wholefome air.

It is difficult to afcertain how far the influence of va-
pours from woods and marines extend ; but there is rea^
fon to think that it is to a very fmall diftance. When
the fhips watered at Rock Fort, they found that if they

anchored

222 CAtfSES AND PREVENTION PART II.

which includes the moil unhealthy time of
the year, without a man dying, and with very
little ficknefs among them, though they
worked hard, lived on fait provisions, and
had their habitations entirely deftroyed by
the hurricane. During this time, near one
half of the garrifon of St. Lucia died, though
in circumftances fimilar in every refpecl, ex-
cept the air of the place, which blew from
woods and marfhes.

The duties of wooding and watering are fo
unwholefome, that negroes, if poffible, fhould

anchored clofe to the more, fo as to fmell the land air,
the health of the men was affected; but upon removing
two cables length, no inconvenience was perceived. I
was informed of the following fa£r, in proof of the fame,
by the medical gentlemen who attended the army in Ja-
maica : — The garrifon of Fort Augufta, which ftands
very near fome marfhes, to which it is to leeward when
the land wind blows, was yet remarkably healthy ; but
it became at one time extremely fickly upon the breaking
in of the fea in confquence of a high tide, whereby the
water which was retained in the hollows of the fort pro-
duced a putrid moiflure in the foil, exhaling a vapour,
offenfive to the fmell, and with all the noxious effects
upon health commonly arifing from the effluvia of
marfhe?.

SECT* I. OF DISEASES. 22J

be hired to perform them. In general, how-
ever, the emplr >v of feamen in filling water
and cutting wood is unavoidable, but it
ihould be fo managed as not to allow them,
on any account, to flay on more all night;
for befides that the air is then more unwhole-
fome, men, when adeep, are more fufceptible
of any harm either from the cold or the im-
purity of air, than when awake and em-
ployed.

As the fervice neceffarily requires that men
mould be on more more or lefs, however un-
wholefbme the air may be, means are to be
ufed to prevent its pernicious impreffions on
the body. Certain internal medicines, fuch
as bitters., aromatics, and imall quantities of
fpirituous liquors, tend to preferve the body
from its bad effects. Of the bitters, Peruvian
bark is, perhaps, the befl; and there is a well-
attefted inftance of its efficacy in the account
given by Mr. Robertfon of a voyage in the
Rainbow to the coaft of Africa ; and by the
fame means Count Bonneval and his fuite
efcaped ficknefs in the camps in Hungary,
wliile half of the army was cutoff by fevers.

224 CAUSES ANB PREVENTION PART II.

Ill confequence of Mr. Robertfon's reprefen-
tation of the effects of bark in curing and pre-
venting the fevers of that climate, the mips
of war fitted out for the coafl of Guinea have
been fupplied with it gratuitoufly, and Go-
vernment would find its account in extending
this bounty to all the tropical flations.

We have feen, in the former part of this
work, that the fever produced by the impure
air of marines may not appear for many days
after the noxious principle, whatever it is, has
been imbibed ; men having been fometimes
feized with it more than a week after they
had been at fea. It naturally occurs, there*
fore, that fomething may be done in the in-
termediate time to prevent the effects of this
bad air ; and nothing is more advifeable than,
to take fome dofes of Peruvian bark, after clea-
ring the bowels by a purgative. Some facts,
related in the firft part of this work, mow that
an interval of ten days or a fortnight may
elapfe between the imbibing of the porfon and
if s taking effect. And in order to guard again ft
the difeafes of this climate in general, it
would be more proper to take fome large dofes

CflAP. I« Or DISEASES. 22£

of bark, once in either of thefe periods, than
to make a conftant practice of taking a little,
as I have known fome people do, by which
they may alfo render their body in fome mea-
ftire infenfible to its good effects. I knew a
phyfician of fome eminence in the Well:
Indies, who always enjoyed uninterrupted
health, and he imputed it to his taking from
half an ounce to an ounce of bark every
change and full of the moon, as he thought
that fevers, of the intermitting and remit-
ting kind, were more apt to occur at thefe
periods. Whether this idea be well founded
Or not, the practice is proper, upon the other
principle that has been mentioned, and the
phafes of the moon will at leaft ferve as an
aid to the memory.

The fpices of the country, fuch as capfl-
cum and ginger, for which nature has given,
the inhabitants of the torrid zone an appetite,
have alfo been found powerful in fortifying
the body againfl the influence of noxious air.
Either thefe, or the bark, or iimilar fubftan-
ces, of a bitter and aromatic nature, given in
a glafs of fpirits to men going upon nn whole-
Q^ fome

aa6 causes and prevention part n.

fome duty, have been found to have a power-
ful effect in preventing them from catching
the fevers of the climate. This practice may
be thought too troublefome in the hurry of
fervice in a great fleet, and I in general avoid
mentioning any thing but what is eafily prac-
ticable, and highly important to the body of
feamen at large, but fuch a precaution may
be of fervice at leaft to officers, or to a lhip's
company, when fervice is eafy, or on a fmali
fcale.

But befides the poifonous effluvia of woods
and marines, the fenfible qualities of the air
are alfo to be attended to. If I were requi-
red to fix on a circumftance, the moll per-
nicious of all others to Europeans, particu-
larly thofe newly arrived in the Well; Indies,
I would fay, that it is exercife in the fun.
The practice moll hurtful next to this is in-
temperance ill drinking, and to one or both
of thefe the licknefs and mortality among
new comers may be afcribed. It is in favour
of this opinion, that women are not fubject
to the fame violent fevers as the other fex,

which

CHAP* li OF DISEASES. 227

which is probably owing to their not being
expofed to the fame caufes of difeafe.

The laft direction I mall mention with
regard to the prefervation of health in a
harbour is, that the (hip mould be made to
ride with a fpring on the cable, that the
fide may be turned to the wind, whereby
a free ventilation will be produced, and the
foul air from the head, which is the mofl
offensive part, will not be carried all over
the decks, as it muft be when the (hip rides
head to wind*

Having little experience of my own with
regard to difeafes at fea in cold climates, I
cannot recommend any particular precau-
tions ; but Dr. Lind thinks that garlick in-
fufed in fpirits is one of the beft preferva-
tives againft the bad effects of cold and wet.

But befides the obvious and fenfible qua-
lities of the air above mentioned, there are
certain obfcure properties which we do not
underftand, and which we find difficult to in-
vefligate ; for there are difeafes prevailing in
Q^z certain

228 CAUSES AND PREVENTION PART 11.

certain places which feem to depend on
fome latent ftate of the air. Of this kind
is the complaint of the liver, fo common in
the Eaft Indies, yet almofr. entirely un-
known in the Weil Indies ; and in the
Wefl: Indies there are certain difeafes which
prevail in one ifland and not in another,
fuch as the elephantiajis * of Barbadoes, which
is an affection of the lymphatics peculiar to
that ifland. In the climates of Europe
there are alfo certain obfcure conditions of
the air that favour one epidemic more than
another, and in fome years more than
others -f. All this is very myrterious to us;
and although we could detect thefe proper-
ties of the air, we probably could not pre-
vent their bad effects, fince man mult every
where breathe the air, whatever its qualities
may be.

* Dr. Hendy has lately publifhed an ingenious irea*
tife upon this difeafe.

f See Sydenham's Worksr

SECT.

CHAP. I. OF DISEASES, 22p

SECT. II.

Of Foul Air from the Neglect of CleanUV
nefs in Men's Perfons — Infection.

IN ATUR E has wifely fo contrived our
fenfes and inftincts, that the neglect of
cleanlinefs renders a perfon loathfome and
offenfive to himfelf and others, thereby
guarding againfr. thofe fatal difeafes that
arife from bodily filth. The noxious air we
fpeak of is generated by men keeping the
fame clothes too long in contact with the
body, while they are at the fame time con-
fined and crowded in fmall and ill-ventilated
apartments. Such is the origin of the jail
fever, otherwife called the fhip and hofpital
fever ; and it feems to be with reafon that
Dr.. Cullen afcribes the low, nervous fever of
Britain to a fimilar origin, being caufed, as
he thinks, by an infection of a milder kind,
ariling in the clothes and houfes of the
Poor, who, from flovenlinefs or indigence,
. 0^3 neglect

23O CAUSES AND PREVENTION PART II,

neglect to change their linen, and air their
houfes.

Man is evidently more fubjecl: to difeafe
than any other fpecies of the animal crea-
tion, owing partly to the natural feeblenefs
of his frame, but Hill more perhaps to the
artificial modes of life, which his reafon
leads him to adopt. There is no circum-
ftance of this kind by which health is more
affected than by clothing. Some ©f the
molt, fatal and peflilential difeafes are pro-
duced and communicated by it ; for we fee
that the greater number of fevers, particu-
larly thofe of the low and malignant fort,
may be traced to the want of perfonal
cleanlinefs.

There are few fubjects more myfterious
and difficult of inveftigation than this of
infection. The origin of fpecific contagions,
fuch as the fmall-pox and the venereal dif-
eafe, feems to be almoft beyond the reach
of a conjecture ; and why all the contagions
we know, excepting that of the bite of a
mad dog, fhould be confined to one fpecies

CHAP* I. OF DISEASES. 231

of animal, their effects not being communi-
cable to any other, is equally unaccountable.
Why is the body incapable of being affected
more than once by certain morbid poifons;
and whence comes the ftriking and curious
differences of fufceptibility to infection in
different individuals at the fame time, and of
the fame individual at different times ?

It would appear that the infection of
fever, which we are chiefly toconfider here,
does not, like fome of the difeafes above
mentioned, depend on the continued propa-
gation of a certain poifon, but that it may
fpontaneoufly arife from a concurrence of
circumflances, producing a long ftagnation
of the effluvia of the body on the clothes,
while people are excluded from the free air
in jails, hofpitals, or mips, without a fupply_
of clean linen.

In order, therefore, to preferve the crews
of (hips from fuch difeafes, means mould be
taken not only to prevent the introduction of
infection already exifting, but to prevent the
generation of it on board.

Q^4 1. Means

232 CAUSES AND PREVENTION PART II.

I. Means of preventing the Introduction of
Infection.

WAR being a ftate of violence and
confufion, in which the hurry and emer-
gency of fervice may be fuch as to render it
impoflible to put in practice all the rules
which might be laid down concerning the
prefervation of health, yet it is neceflary
that thofe who direct the navy, either in
a civil or military capacity, mould be aware
of the caufes of ficknefs and mortality, in
order to 'guard againfh them as far as is prac-
ticable. From the idea of the hardfhips
and inconveniencies of war being unavoida-
ble, I have known neglect to arife, as if it
was not the duty of a commander to em-
ploy the utmoft attention to alleviate the
misfortunes, and mitigate the fufFerings, of
his fellow creatures ; and we have feen that
much more of the calamities of war arife
from difeafe than from the fword. The
Jike excufe might be framed for the neglect
pf Hores and arms, which the hurry of fer-
vice

CHAP. I. OF DISEASES. 233

vice might equally expofe to injury. We
fee, indeed, infinite pains taken to prevent
cordage from rotting, and arms from Tuft-
ing ; but however precious thefe may be as
the neceffary refources of war, it will not be
difputed that the lives of men are ftill more
fo ; yet, though there is the additional in-
ducement of humanity to watch over the
health of men, I do not think that this, in
general, is fhidied with a degree of attention
equal to what is beftowed on fome inanimate
objects.

Ships of war are expofed to infection
chiefly by receiving fuch men as have been
raifed by prening, who are frequently con-
fined in guard-fhips, under fuch circum-
flances of bad air and bodily filth as tend to
generate the moll: virulent infection. The
fervice alfo requires fometimes that men be
received from jails, and they are either cri-
minals delivered over by the civil jurifdic-
tion of the country, or captives who have
been re/lored by the enemy after a courfe of
confinement in their prifons, It may hap-
pen too, as we have feen*, that the enemy,

* See Part I. Book II. Chap. VI.

who

234 CAUSES AND PREVENTION PART II.

who are made prifoners at fea, may have in-
fection about them, and will communicate
it the more readily that they are ftrangers.

There are few fevers but what are infec-
tious at fome ftage or other of the difeafe ; but

itisnotneceifary that fever mould actually exift
in order to create infection. In the moft vio-
lent and peftilential fevers, fuch as have
ibmetimes originated in the jails of England,
the perfons who communicated them were
not affected with it themfelves*. Infection,
like fome other poifbns, does not affect thofe
who are accuftomed to it, and therefore
thofe who are in the habit of being expofed
to it frequently efcape its bad effects, ef-
pecially if it is gradually applied, as mult
be the cafe with thofe about whofe perfons
it is generated. For the like reafon, physi-
cians and nurfes are lefs fufceptible than
others ; and Grangers, who are accuftomed
to a pure air, are the moft fufceptible of any .
It is obferved by Dr. Short, that contagious
epidemics are more frequent and fatal in

* We have a proof of this fa6t in particular in the ac-
count of the jail difternper, which broke out at the Old

Bailey in the year 1750.

the

CHAP. I. OF DISEASES. 235

the country than in London, and this may
probably be accounted for on the fame
principle ; for every perfon in a great town
is expofed to the breath and effluvia of
others, and to a variety of putrid exhala-
tions, which are unavoidable where multi-
tudes inhabit together ; but they are fo ufed
to them, that they are not thereby affected;
whereas in the country, where people are
lefs accuftomed to each other's company,
and lefs ufed to impure air in general, they
are the more readily affected when infection
is introduced among them. It may even ad-
mit of a doubt if any fociety of men, living
together, are entirely free from morbid con-
tagion. It certainly fometimes happens,
that a fhip, with a long eflablimed crew,
mall be very healthy; yet, if Grangers are
introduced among them, who are alfo heal-
thy, ficknefs will be mutually produced.
This principle in the human conftitution,
by which the prefence of flrangers affects it,
is well illuftrated by a fact*, founded on

* See Martin's Hiftory of the Weftern Iflands, and
Medical Communications, Vol. I. page 6&,

the

236 CAUSES AND PREVENTION PART II.

the heft teftimony, that in one of the fmall
wefterji iflands of Scotland, which is fo re-<
mote that the inhabitants are frequently
without any communication with ftrangers
for months together, and in confequence of
this long interruption of intercourfe they
become fo fufceptible, that they are feized
with a catarrh when ftrangers of any de-
fcription come among them. It was faid
before, that cleanlinefs was founded on a
natural averfion to what is unfeemly and
ofFenfive in the perfons of others ; and there
feems alfo to be an initin&ive horror at
ftrangers implanted in human nature for
the fame purpofe, as is vifible in young chil-
dren and uncultivated people. In the early
ages of Rome, one word fignified both a
granger and an enemy*.

Thefe

* There are fome contagious difeafes which cannot be
propagated but by their own peculiar infection, as has
been before obferved, jufl as the feeds of vegetables are
neceffary to continue their feveral fpecies ; fo that if the
infectious poifon were loft, fo would the difeafe. Of
this kind are the fmall-pox, and the other difeafes to
which man isfubje£t but once during life. There are other

difeafes

CHAP. I. OF DISEASES. 2J7

Thefe obfervations naturally fugged: ieve-
ral ufeful and pra&ical remarks. It would

appear

difeafes which produce infection without having them-
felves proceeded from it. Of this kind are fevers and
fluxes.

But there is no infection of any kind, however viru-
lent, that affects indiscriminately all perfons expofed to
it. If a number of perfons, who never have had the
fmall-pox, are equally expofed to it, fome will be feized,
while others will efcape, who will be affected at another
time, when they happen to be more fufceptible. It is
doubtful how far the habit of being expofed to fuch fpe-
ci£c infections renders the body infenfible to them, as
was faid with regard to fevers j but there is another prin-
ciple of the animal ceconomy laid down and illuftrateci
by Mr. Hunter, which goes at leafl a certain length in
explaining this variable ftate of the body with refpect to
its fufceptibility of infectious difeafes. This principle
is, that the body cannot be affected by more than one
morbid action at the fame time. If a perfon is expofed
to the fmall-pox, for inftance, while he labours under a
fever, or while he is under the influence of the meafles,
he will not catch the firft till the other has run its courfe.
It may happen, therefore, that people efcape the effect of
contagion in confequence of being at the time under the
influence of fome other indifpofition, either evident or
latent : and fuppofing the body to be expofed to a num-
ber of noxious powers at the fame time, one only could

take

238 CAUSES AND PREVENTION FART Mi

appear that the utmoft attention is necefTary
not only to guard againft thea&ualprefence of

difeafe,

tike effect. But it feems difficult to explain why fome
of thofe who are actually feized, and who have previoufly
been to all appearance in equally good health, fhall have
it in a very mild degree, while in others it will be malig-
nant and fatal.

It would appear from thefe confederations, that there ,
are certain circumftances, or temporary fituations of con-
stitution, which invite infection, and render its effect
more certain and violent in one cafe than another*
There are artificial methods, however, of obtruding it,
as it were, upon the conftitution, though not particu-
larly difpofed, or even though averfe to receive it; and
may not this in fome meafure account for the greater
fafety of fome difeafes when communicated by inocula-
tion, than when caught in the natural way ?

But thefe, as well as many other facts in animal nature,
do not admit of a fatisfactory explanation upon any prin-
ciple as yet known. Even the moft common operations
of the body, fuch as digeflion and generation, when
confidered in their caufes and modes of action, are fo ob-
fcure and myfterious as to be almoft beyond the reach of
rational conjecture. A little reflection will teach us the
utmoft modefly with regard to our knowledge of fuch
things; for nature feems to have innumerable ways of
working, particularly in the animal functions, to which
neither our fenfes can extend, nor perhaps could our in-
tellects

CHAP. I« OF DISEASES. 23=9

difeafe, but to be jealous of all new draughts
of men, efpecially if they came from guard-
(hips, jails, or tenders, and have been turned

over

telle&s comprehend them. Had we not, for infianpe,
been endowed with the fenfe of fight, nothing could have
led us even to fufpecl: the exiftence of fuch a body as
light ; and there may be numberlefs other fubtle and ac-
tive principles pervading the univerfe, relative to which
we have no fenfes, and from the knowledge of whofe
nature and exiftence we muft for ever be debarred- We
have, indeed, become acquainted with electricity by an
operation of reafon ; and animals have lately been difoo-
vered to which the ele6lric fluid ferves as a medium of
fenfe through organs calculated to excite it, and to receive
and convey its impreffions.

But there are few fubje&s we can ftudy that are more
fubtle and obfcure than the influence of one living body
on another. There is a familiar inftance of the great fu'b-
tlety of animal effluvia, and alfo of the iinenefs of fenfe
in a dog's being able to trace his mailer through crowds,
and at a great diftance ; and we can conceive that infec-
tious matter may adhere, and be communicated in a fimi-
lar manner. We endeavoured to illuflrate the great ob-
fcurity of its operation by an allufion to generation, di-
geftion, and other animal functions, with which it is
equally obfcure and inexplicable. It is fimilar to gene-
ration in this, that its influence does not pafs from one
fpecies of animal to another ; for the poifen of the plague,
that of the fmall-pox, that of fever, and the venereal

difeafe.

240 CAUSES AND PREVENTION PART Ii,

over from mips where difeafe is known to
have prevailed ; nay, it is bed to avoid mix-
tures of any kind.

difeafe, do not affect brutes*, nor do the infectious dif-
eafes of brutes affect different fpecies of them, nor the
human fpecies. The only exception to this, that we
know of, is the bite of a mad dog.

From thefe facts, and alfo from what was formerly
mentioned of contagion not affecting indifcriminately all
that may be expofed to it, it would appear that fome nice
coincidence of circumftances is neceflary to modify an
animal body, fo as to receive its action. There mull be
a fort of unifon, as it were, or fympathy betwixt diffe-
rent living bodies, fo as to render them fufceptible of
each other's influence.

It is none of the leaft curious facts with regard to in*
fection, that there are fome fpecies of it by which the
body is liable to be affected only once in life. When
this is confidered, it isjndeed conformable to what hap-
pens in the courfe of the difeafe itfelfj for, nnlefs there
was in the body a power of refilling it, there could be no
fuch thing as recovery. Where the difeafe actually exiftss
the continued prefence of the poifon, which is alfo infi-
nitely multiplied, would infallibly deflroy in all cafes, un-
lefs the living powers were to become infenfible to it f»

* Mr. Hunter's Experiments.
i Mr. Hunter's Le&ytes*

The

CHAP. II. OF DISEASES. &4t

The infection of fevers feems different
from moll: others in this, that it is very-
various in its degrees of virulence. There
is reafon to think that the poifon of the
fmall-pox, and that of the veneral difeafe,
are in their own nature invariable, and that
the difference of thefe difeafes, in point of
malignancy, depends on the conftitution and
other circumftances ; but that of fevers be-
ing of different degrees of activity, and be-
ing frequently obfcure and latent, is, on that
account, the more treacherous, and ought to
be watched with the greater circumfpection.

The mode of manning the navy by preffing,
I take it for granted, is unavoidable ; at any
rate it would not become me to arraign a prac-
tice which has had the public fanction for ages.
It is, however, one of the principal means
both of generating and fpreading the feeds
of difeafe, in confequence of the mdifcrimi-
nate feizure of men for the public fervice,
and the confinement that is neceffary to fe-
cure them. And as the exigencies of the fer-
vice make it neceffary to admit perfons of
every defcription, there is no other remedy-
It for

242 CAUSES AND PREVENTION FART II.

for this evil but to annihilate, if poflible,
the contagion that may thus be conveyed
into fhips of war. This is done by Grip-
ping and warning the new recruits who may
be fufpected of importing infection ; alfo by
cutting- off their hair, cloathing them with
new clothes, and destroying the old, before
they are allowed to mix with the fhip's com-
pany in which they are to enter.

Thofe who have put thefe methods ft rich-
ly in practice, have been fenfible of their
great utility ; and the moft exact attention
is neceflary, as a fmgle infected man, or
even any part of his cloathing, may fpread
ficknefs through a whole fhip's company.
When we reflect what havock an infectious
fever fometimes makes in a fhip, it will ap"
pear how very important this fort of atten-
tion is ; and when the caufe of the fickli-
nefs of particular fhips is traced to its
fource, it will generally be found to have
originated from taking on board infected
men at Spithead, or wherever elfe the fhipV
company may have been completed.

After

chap. r. or diseases. 243

After the firfr. edition of this part of the
work was printed > an excellent inflitution
was eftablimed at Portfmouth for the preven-
tion of infection. A fhip was appointed
for the reception of the recruits of the
fleet, to which they were carried, to be
{tripped, wafhed, and provided with new
apparelj before they joined their refpective
(hipSi This had a vifible good effect on
the health of the fleet; and it was planned
and r executed by Sir Charles Middleton,
Comptroller of the Navy, whofe unwearied
affiduity, as well as integrity and ability in
that important poll:, claim the highefl praife
and gratitude from his country.

It follows farther, from the preceding
obfervations, that there is a fort of rifque in
mixing two different forts of men, even
when there is no actual difeafe or fufpicion
of infection ; for, whether it is from dor-
mant infection, or merely from the circum-
ftance of change of air, fuch mixtures are
known from experience to be fometimes
productive of ficknefs. The late Admiral
Bofqawen was fo fenfible of this, that he
R 2 avoided

244 CAUSES AND PREVENTION PART II.

avoided it, imlefs when fome evident utility
or neceffity of fervice made it proper ; and
upon this principle he ufed to refift the foli-
citation of captains when they requefted to
carry men from one mip to another, upon
changing their command.

One probable reafon, among others, for
mips of the line being more iickly than fri-
gates or fmaller mips is, that in greater
numbers there is a greater chance of men
of various defcriptions and modes of life
being mixed together.

2. Means of preventing the Production of
Infection.

THE infection of fever is not always im-
ported from without, but may be originally
and fpontaneoufly generated on board. The
caufes of this, as mentioned before, are want
of perfonal cleanlinefs, and alfo confinement
and crowding in clofe apartments.

In order to promote cleanlinefs, care fhoyld
be taken that every man, on his firfl enter-
ing

CKAP. II. OF DISEASES. $45

ing into the fervice, be provided with a pro-
per change of linen, and that a frequent
m ufter and review be made, in order to in-
fpe6l their perfons, and to examine their
ftock of apparel. A true feaman is in ge-
neral cleanly, but the greater part of men
in a fhip of War require a degree of compul-
fion. to make them fo ; and fuch is the de-
pravity of many, that it is common enough
for them to difpofe of their clothes for mo-
ney to purchafe fpirituous liquors. A muf-
ter and review, therefore, wherein men
fhould be obliged once in the week to pre-
fent themfelves clean before their officers,
and to produce a certain neceffary quantity
of clean apparel, would conduce both to
fobriety and cleanlinefs, The exertion of
authority, and the infliction of punimment,
is fo far from being confidered by the men
as a hardftiip, that they expect it ; and it is
the duty of an officer, as it is of a parent to
a child, to conftrain thofe entrufted to his
care to perform what is for their good. It
is common alfo for men to lay up their
clothes in a wet and unwafhed ftate, which
R 3 in

246 CAUSES AND PREVENTION PART XX.

in time is productive of the moft ofFenfive
and unwholefome vapours ; and this can be
prevented only by their chefls and bags
being frequently infpe&ed by their fupe-
riors.

It muft be evident to any one who reflects
on this Subject, that a regulation of this
kind is as neceffary as any other part of
duty ; and it deferves to be made an article
in the public inflruclions, instead of being
left to the difcretion of officers. This fort
of discipline is particularly neceffary in fhips
of the line, in which one caufe of the greater
imhealthinefs is the difficulty of taking cog-
nizance of fo great a number ; for, unlefs
fome regular method, as by mufler, is efta-
blifhed, there will be men who will efcape
notice, and Ikulk below indulging in lazi-
nefs and filth.

The good fenfe and humanity of many
captains in the late wTai\ led them to adopt
certain methodical regulations for the pre-
servation of cleanlinefs and order. The only
public fan&ion given to this fort of difcipline,

was

CHAP, I. OF DISEASE!. 247

that of Lord Howe, wko gave it in orders
to thofe under his command, that each
fhip's company mould be divided into as
many diviiions as -there were lieutenants,
and that thefe mould be divided into fquads,
with a midfhipman appointed to each ; and
that the officers mould be refpectively refpon-
fible for the good order and difcipline of the
men affigned to them.

It is an excellent cuftom, and pretty ge-
neral in the navy, to allow the men one day
in the week for warning, when the weather
and other circumftanees will admit of it.
It would be a farther improvement in the
rules of the fervice to fupply foap in the
fame manner as tobacco and flops are fup-
plied, that is, to let the men have what
quantity they want from the purfer, who
is allowed to charge it againft, their wages.

Next to want of cleanlinefs, the circum-
ftances moll: apt to give rife to infection are,
clofe air and crowding. A certain length of
time is neceffary, in order that thefe fhould
have this effect, and the longer they take
place, the more certainly will infection be
R 4 produced.

248 CAUSES AND PREVENTION PART II.

produced, and it will be the more viru-
lent *.

In order to admit air freely, the ports
fhould be kept open whenever the weather
will permit this to be done; and frequent fires
in the lower parts of the fhip will tend to
produce a falutary draught of air, as well
as to remove moifture.

The hammocks and bedding fhould alfo
be aired by expofing them upon deck, efpe-

* At the time I am writing this, (March 8th, 1)85)
there has occurred a fa<5t which proves the effect of time
in generating infection. There now prevails a contagious
fever in feveral of the hofpitals in London, and, among
others, in that to which I am phyfician. In another hof-
pital it has been fo violent, that there has been a vulgar
report that the plague had broke out in it. The fame
fever alfo prevails among the poor at their ow,n hpufes.
The caufe of it feems to be, that the cold weather has
been uncommonly Jong and fevere ; for the frofl began
early in December, and the cold has hitherto been more
like that of winter than fpring. The thermometer all
this month has varied from 30° to 350. Cold is favoura-
ble to infection, by preventing ventilation ; for people
exclude the air in order to keep themfelves warm, and
the poor in particular do fo. on account of their bad
cloathing, and their not being able to afford fuel to make
good fires. Heat is the great deftroyer of infection, and
feems to act by evaporating, and thereby diffpating it.

cial ly

CHAP. II. OT DISEASES. 249

daily after the ports have been long fruit hi
confequence of bad weather. They cannot
be thoroughly aired unlefs they are unlafh-
ed ; and as this could not be conveniently
done daily in men of war, it might be done
from time to time by the different diviiions
in rotation *. When the men come to fleep
upon them after thefe operations, they ex-
perience the fame agreeable fenfations as
from a change of linen ; and this muft con-
duce to health as well as pleafure, like all
other natural and moderate gratifications.
Jt may. be farther remarked in favour of
cleanlinefs, that it is not only directly con-
ducive to health, but is naturally connected
with habits of good order, fobriety, and
other virtues. The moft cleanly men are
always the moll: decent and honeft, and the
moft flovenly and dirty are the moft vicious
and irregular.

A fhip of war muft have a much greater
number of men on board than what are ne-
ceflary to navigate her ; for, befides the

* It is of fome confequence to attend to the materials of
the feamens' beds ; for inflead of flock, they are frequently
{luffed with chopped rags, which confifting of old clothes,
emit a difagreeable fmell, and may even contain infection.

marines,

2$3 CAUSES AND PREVENTION PART II.

marines, a great many hands are neceflary
to man the great guns in time of aclion.
For this reafon, there is a greater rifque of
the inconveniencies of overcrowding than in
fhips intended for commerce, and therefore
much greater attention is neceflary with re-
gard to ventilation and cleanlinefs. There
is a piece of management which tends alfo
in fome meafure to obviate the neceffity of
crowding. This is to berth the watches al-
ternately, by which it is meant, that one half
of each watch mould lie on different fides,
whereby they do not deep fo clofe, and are
not fo much expofed to each other's breath
and to the heat and effluvia of each other's
bodies. This has the farther advantage of
preferving the trim of the fhip.

What has been faid of the fhip and men
in general, applies {till more ftrongly to the
lick, and the berth * afligned to them. The
befl part for the accommodation of the rick
in a fhip of the line, is under the forecaftle

* By a berth is underflood the interval between two guns,
or any fpace between decks, which is fometimes formed
into a fort of apartment, by means of a partition made of
canvafs.

pHAF. t. OF DISEASES. 251

in a warm climate, and on the fore part of
the main deck in a cold one. When under
the forecallle, however, they ought to oc-
cupy only one fide, as they would otherwife
be difturbed by the men, who mull: pafs
to and from the head, 'and the men in
health would, in this cafe, be expofed
alfo to contagion. As infe&ion is moll
likely to arife among the lick, attention to
cleanlinefs and air is doubly requifite where
they lie ; and it has a good effect to fprinkle
hot vinegar and diffufe its fleams among
them once or twice a day.

Thus we fee that cleanlinefs and difci-
pline are the indifpenfable and fundamental
means of health, without which every other
advantage and precaution is thrown away.
Government never bellowed more attention
and expence upon the victualling of the navy
than during the late war ; but it would be to
little purpofe to provide the moll nourilhing
and antifcorbutic diet, the moll wholefome
and cordial wines, the moll efficacious reme-
dies, arid the moll ikilful phylicians and
furgeons, if the men are not conltrained
to keep their perfons fweet, their cloathing

and

PART II.

and bedding clean, and their berths airy and
dry. It is, therefore, upon officers more
than any others that the health of the fleet
depends ; and I mould be excufed in the
frequent mention I make of this, were it
known how often I have been the witnefs of
the fatal effects of the neglect of thefe rules.

3. Means of eradicating Infection.

WHEN, from a neglect of the means
above mentioned, an infectious fever comes
actually to prevail, and the infection, per-
haps, adheres obftinately to the fhip in
fpite of cleanlinefs, good air, and diet, and
all the other means that would have pre-
vented it, then fome meafures are to be
taken for eradicating this fubtle poifon.

The firft {rep towards this is, to prevent
the difeafe from fpreading, and this is done
by fep a rating the fick from the healthy,
and cutting off all intercourfe as much as
poffible. For this end, it is neceilary to
appropriate a particular berth to contagious
complaints, and not only to prevent the

idle

CHAP. II. OF DISEASES. 253

idle vifits of men in health, but to difco-
ver and feparate the perfons affe&ed with
fuch complaints as foon as pofiible, both
to prevent them from being caught by
others, and becaufe recent complaints are
moil manageable and curable. Officers
might be very ufeful in making an early
difcovery of complaints, by obferving thofe
who droop and look ill in the courfe of
duty; for feamen think it unmanly to
complain, and have an averfion to be put on
the fick lift. I have heard of a method
pra&ifed in fome fhips, of keeping a book
on the quarter deck for the officer to mark
the names of fuch men as might look ill, or
might be miffed from duty upon calling the
roll, in order to afford the furgeon a means
of rinding out thofe who mould be the objefls
of his care.

Thofe whofe profeflion it is to fuperin-
tend the health of the fhip, would find it
ibr their eafe and intereft, and fhould confi-
der it as their duty, to walk over the diffe-
rent decks once a day, or every other day,
in order to make an early difcovery of thofe

who

254 CAUSES AND PREVENTION PART IX.

who may be taken ill. Though I have laid
great itrefs on the duty of the commander,
as the proper guardian of health, yet his
affiduity will not avail unlefs the furgeon
alfo does his part, by fuch acts of attention
as I have mentioned, joined to (kill in his
profeffion.

Surgeons are, perhaps, more regarded in
our fervicethan in that of other nations ; but
it would be for the public benefit if they
were ftill more refpected and encouraged* To
men of liberal education and fentiments, as
furgeons ought to be, and generally are, the
moft effectual inducements for them to do their
duty are flattering attentions, and a certain
degree of eflimation in the eyes of their
officers. Liberality of manners on the part
of fuperiors is the moft likely means of en*
couraging a confcientious performance of
duty ; for though ftrict and diftant beha-
viour may operate upon the minds of thofe
whofe functions are merely mechanical,
how can it infufe that tender attention to
human fufferings, and that fenfe of duty*
z which

CHAP. I. *>F DISEASES. 255

which may induce a man entruiled with the
health and lives of his fellow-creatures to act
his part with propriety and effect ?

In order to prevent ficknefs from fpread-
ing, it is not fufhcient to cut off all per-
fonal intercourfe. The clothes of .men are
as dangerous a vehicle of infection as their
perfons ; and it mould he a ftricl: and inva-
riable rule in cafe of death from fever, flux,
or fmall-pox, to throw overboard with the
body every article of cloathing and bedding
belonging to it.

Upon the fame principle, in cafe of reco-
very from any contagious difeafe, as if
would be too great a wafle to deftroy the
clothes and beds, they mould be fmoked,
and then {crabbed or warned before the
men join their mefTes and return to duty,
This precaution is the more neceflary, as
infection in a fhip is extremely apt to be
communicated by bedding, from the cuflom
of flowing the hammocks in the netting,
by which they are brought in contact with
each other. This, however, is an excellent
cufbom, as it not only clears the fhip below

and

256 CAUSES AND PREVENTION PART II.

and ferves to form a barricade on the gun-
wale, but tends to air the bedding ; and
this falutary effect fhould not be prevented,
except in cafe of rain, by the coverings,
called hammock-cloths, by the ufe of which,
utility is evidently facriflced to an excefs of
neatnefs.

It fometimes happens that the number of
fick in a fhip is fo great, that it is not pof-
fible to take proper and effectual meafures on
board for flopping the progrefs of difeafe.
But when fhe can be cleared of the lick by
fending them to an hofpital, no pains fhould
be fpared to extirpate the remaining feeds of
infection.

For this purpofe, let their cloathing and
bedding be fent along with them ; let their
hammocks, utenfils, and whatever elfe they
leave behind, be fmoked, and either fcrub-
bed or wafhed before they are ufed by other
men or mixed with the fhip's flores ; let
the decks, fides, and beams of their berths,
be well wafhed, fcraped, fmoked, and dried
by fire; then let them be fprinkled with

hot

CHAP. t. OF DISEASES,, Q,§J

hot vinegar, and, finally, white-waflied all
over with quick lime.

Should any officer object to the trouble
and inconvenience of all this, let him re-
flect for a moment how much more trou-
blefome and inconvenient, as well as noi-
fome and difagreeable, iicknefs itfelf proves
to be ; let him reflect that the efficiency of
the fhip, confidered as a bulwark of defence,
depends on the number of healthy hands,
and that his own character is to depend on
the exertions to be made by them, not to
mention the attention due from him as a man
to the fufferings of the objects themfelves.

But belides thefe recent infections, it
fometimes happens that the feeds of di£
eafe adhere to the timbers of a fhip for
months and years together, and can be
eradicated only by a thorough cleaning
and fumigation. Sweeping, warning, fcra-
ping, and airing, are not fufflcient entirely
to remove the fubtile infectious matter ; but
they will aflift, and will prepare it to be
acted upon by heat and fmoke, which are

S the

2$% CAUSES AND PREVENTION PART 2'lV

the only means to be depended upon. A
complete fumigation can only be performed
when the fhip is in dock ; and I mall here
tranfcribe a method recommended by Dr.
Lind.

44 It will be proper to remove every
44 thing out of the fhip, fo that the hold
44 may be fwept, and, when the men have
u withdrawn, to light a number of char-
44 coal fires in different parts, and to throw
44 a handful or two of brimftone on each*
44 The fleam of thefe mould be clofely con-
fined by fhutting the ports and hatch-
ways from morning till evening, no per-
fon in the mean time being allowed to
go below, nor for fome time after open-
ing the ports and hatchways, that the
{team may be difperfed.

44 In order to purify the men's clothes,.
44 it would farther be proper to fumigate
44 the hulk into which they are removed
44 with tobacco once or twice a week while
44 their fhip is in dock, the men remaining
44 below as long as they can bear it.

44 The

t'frAP. U t>F DISEASES. ^5f

«* The clothes and hammocks of the men
** fhould be expofed in the hulk to the
5< fmoke of the tobacco, and thofe which
" aire more particularly fufpected, may be
" hurig up in the fhip, and expofed to the
" fleam of the charcoal and brimftonCi

46 The fhip having been already fumi-
" gated with tobacco, it will be fufficient
8* to ufe the fumigation of charcoal and
44 brimftone above defcribed for three days*
se and, after the Iaft day's fumigation, the-
61 infide of the fhip fhould be well warned
" with boiling vinegar, and, before the men
&i return on board, all the decks fhould be

fcraped and warned.'*

When a fhip is at fea, thefe precautions
cannot be taken fo completely ; but if in-
fection is prefent, or is fufpe&ed, then
cleanfingand fumigating may be pra&ifed in
a lefs degree. I have known a fhip at fea fu-
migated with gunpowder kneaded with vine-
gar, fo as to prevent it from exploding, and to
make it burn flowly with a fpattering flame.
Flowers of fulphur, with about an. eighth
part of nitre, will anfwer ftill better. A
S z quantity

36o CAUSES AND PREVENTION FAP.-T gfr

quantity of thefe is placed in each interval
of the guns between decks, every perfon
being turned up, and the ports and hatches
fliut till they are confumed, and till the
fmoke has difperfed. It has alfo a good ef-
fect to burn refinous bodies, fuch as the
woods of fir, fpruce, and juniper, as the
fmoke of thefe is more falutary. Upon the
fame principle, the effluvia of tar are whole-
fome ; and the cables that are coiled in the
lower parts of a fhip being forked with tar,
like moil of the other ropes of a fhip, pro-
bably conduce very much to the health of a
place otherwife dank and unwholefome.
Fumigation may alfo be performed by means
of tar, either by throwing it on red-hot irons,
or a wood fire, which may be carried about
between decks in a pot or moveable grate,
or over fome cannon balls in a tub, or by
immerfing a red-hot loggerhead^ in a buc-
ket of tar. If this is done in the place oc-
cupied by the fick, it will have a {till better
effect ; and it will be of fervice to them to
be removed for a fhort time under the half

* A loggerhead is a large round inafs of iron, with1 a
long handle to it.

deck

CHAP. 1. OF DISEASE 6. 26 1

cdeck or forecaftle till this or other means
of purification are put in practice. In what-
ever manner fumigation is performed, it
will be of fervice to fpread out the clothes
and bedding of the men, or to hang them
upon lines, that they may be expofed to the
heat and fmoke.

It will alfo be of great fervice to make
the men expofe their frowfy clothes to the
fun and wind. If a ftrong infection is fuf-
peeted, and it cannot be afforded to deftroy
the clothes, the beft means of certainly era-
dicating the poifon is to hang them for a
length of time over pots of burning brim-
itone in a large calk {landing endways, with
fmall apertures to admit air enough for
the brimftone to burn.

Fire in every fhape is to be confidered as
the principal instrument of purification, by
its heat perhaps ftill more than its fmoke ; and
it will be remarked hereafter, that infection
as lefs common in hot than in cold climates.

S3 SECT.

$62 CAUSES AND PREVENTION *A&T l\%

SECT. III.

Of the Foul Air generated in a Ship.

I MEAN here to diftinguifh the unwhole*
fome vapour produced by the contents of
the fhip from the infection produced by the
effluvia of men's perfons, which was treat*
ed of in the laft fection.

The means of preventing this foul air
from being generated are, cleanlinefs, dry««
nefs, and ventilation.

All parts of a fhip may, if neglected, be-
come dirty, and emit an offeniive vapour \
but the parts under water confuting of the
orlop and hold, are more particularly fo
from the materials they contain, and from
the want of free accefs to the frefh air ; ac-
cordingly, there is always more or lefs
ffench in thofe parts, even in the beft-regu«»
lated {hips.

%H. AT. I. OF DISEASE S. 263

It was mentioned in the firfr. part of this
work, that an opinion was entertained by
fome that no foul air was productive of fe-
vers but fuch as proceeds from the living
human body. I alledged that this was
otherwife, at leafr, in hot climates ; and
fome proofs of this opinion were adduced,
particularly from the French-prizes. Though
the negiecl: of perfonal cleanlinefs is the
principal fouree of difeafe, yet cleanlinefs
of every kind, and purity of the air in every
refpecl:, is to be anxiouily ftudied-

With regard to general cleanlinefs, it is
•hardly necefi'ary to mention fweeping, warn-
ing, and'fcrubhingof the decks; for the natu-
ral propensity of the Englifh* nation to neat-

nefs,

* This circurnltance in the chara&er of the Englifh
is only of modern date ; for we learn from Erafmus, who
was in England about two hundred and fifty years ago,
that they were then extremely fiovenly. The following
pafTage is extracted from a letter he wrote to a phyfician
in York, after his return to Holland: — " Conclavia fola
*' fere ftrata funt argilla, turn fcirpis poluflribus, qui f*«
J* binde fie renovantur ut fundamentum maneat aliquo-
** ties annos viginti fub fe fovens fputa, vomitus, mic-

S 4 « turn

264 CAUSES AND PREVENTION PART II,

nefs, feldom allows any neglect of thefe.
Lord Howe, to whofe virtues as a man, and
abilities as an officer, his country is fo much
indebted, gave it in general orders to warn the
upper decks every day, the lower decks twice
a week, and the orlop once a week at leait.
He alio ordered that every wafhing, fmo-»

king,

" turn canum et hominum, proje£tam cerevifiam et prf-
V cium reliquias, aliafque fordes non nominandas." He
adds, that the windows were very ill calculated for ven-
tilation, and imputes to the clofenefs and filthinefs of the
houfes the frequent and long-continued plagues with
■which England was infefled, and particularly thefweating
fLcknefs, which, he fays, feemed peculiar to this coun-
try. He mentions that his own country had been freed
from the peftijence by certain changes that the State had
rnade in the houfes, in confequence of the advice of fome
learned man. Erafm. Lib. xxii. Epiftol. 13. — It is
probable that the greater number of thofe epidemics,
called plagues, were only bad infectious fevers. What
would contribute ftill more to the production of infec-
tion, was the want of linen, which was hardly in ufe in
thofe days. The difappearance, or at leafl the great dU
minution of fuch complaints in modern times, particu-
larly in London, has been afcribed to the great increafe
in the proportion of vegetable food ; but it is perhaps
ynore owing to the improvement in perfonal cleanlinefs,
and tQ the greater fpacioufnefs and neataefs of houfes.

TherQ

CHAP. I. OF DISEASES. 265

king, muttering, and review of clothes, or
any other means taken for the health of the
fhip, mould be marked in the log-book,
and the reafon to be affigned there if omit-
ted at the ftated times. Thefe rules are a

There are fome pafTages in ancient hiftory in confirm-
ation of the fame opinion. Herodotus relates, that the
ancient Egyptians were the moft healthy of all the na-
tions, except the Libyans, and he imputes this to the in-
variablenefs of their weather, and the ferenity of their
iky. But he mentions in another part of his works,
that they were alfo the moll cleanly of all people, not
only in their houfehold utenfils, but in their perfons, and
that their clothing was chiefly of linen, which it was
one of the principal ftudies of their life to wafh and keep

clean — I*/**t* oe Xtvsct. QogEtxrt aitt vwrrhvrx lirnqhvortts t«t«
pahiru, Herodot. Euterp. 37. — It is remarkable that he
makes no mention of the plague, though he gives a very
minute account of the country from his own obfejvation,
from whence it may be naturally inferred, that it did not
then exift there, though Egypt is now fo fubjedl to it,
that the plague is fuppofed by many to be an endemial
difeafe in it. It would appear alfo from another paffage
in this hiftorian, that he ufes the word Aoi^o?, which we
translate plague in a loofe fenfe to fignify any violent
acute diftemper ; for he relates that a great part of the
army of Xerxes, in their retreat from Greece, perifhed
by the plague and dyfentery, in conference of famine.
Herod. Lib. viii. cap. 1 15.

good

CAUSES AND fREVlNTION PART U,

good fpecimen of the order that ought to
prevail in every branch of public duty ; for
it is well known to every experienced officer
that it is a methodical proceeding of this
kind which can alone render fervice either
cafy or effective.

The lofs of men's lives from the foul air
of the well, is a common accident in mips,
and I have been myfelf witnefs to feveral
Inftances of it. Where there is the leafl
fufpicion of this, a candle mould previoufly
be let down, and if it mould be extinguim-
ed, it may be concluded that the air is
deadly. It becomes fafe for men to breathe
m It by leaving it open for fome time, or,
more expeditioufly, by letting down fire in
a pot or grate, which foon changes the air,
by producing a draught of it. upwards.

It is a very falutary practice to let down
fires frequently into the well, both in order
to purify the air and to dry the furrounding
parts. It was formerly mentioned that this
was daily done in the Intrepid, and the effect
of it was to remove the wetnefs of the bal-
Jail and the mouldinefs which had overfpread

the

,-€HAP, I* OF DISEASES. 36?

the fides and beams ; and having had the ef-
fect of fweetening and purifying the air, it
feemed to be the principal circumflance that
tended to make this fhip extremely healthy
from being the moft fickly of all the fleet*
This precaution, as well as every other point
of cleanlinefs, is more necefTary in large
fhips, becaufe the mafs of foul air, as well
as the quantity of corrupting materials, is
greater.

The following fact ftrongly evinces the
good effect of fire and fmoke ; — When it
was the cuftom for frigates to have their
kitchens between decks, they were much
more healthy than in the prefent conflruc*
lion, in which they have them under the
forecafUe, where the heat and fmoke are
diffipated without being diffufed through the
Ihip, and caufing a draught of air upwards
as formerly. The men derived then alfo
great benefit and comfort from having a
large fire, round which they might aflem«?
ble to warm and dry themfelves in a fhel-
tered place. I leave it to thofe who prefide
)n the conftru&iqn of the navy, to deter-
mine

£.65 CAUSES AND PREVENTION FART IT.

mine how far it would be advifable to re-
turn to the old manner of conftruction.

Moifture is pernicious both in itfelf and
as the inftrument of putrefaction. All the
complaints, called colds, are more owing to
wet than cold ; and moifture may be the
means of producing, or at leaft of exciting
dangerous fevers, when they would not
otherwife appear. It belides contributes
greatly to the production of fcurvy. Ships
built of ill-feafoned wood are found to be
very unhealthy on account of the moifture
contained in it. The moifture of timber
arifes not only from being ufed too foon after
being felled, but alfo, as I am informed, from
being ftripped of its bark and outer furface
when piled and expofed to the weather in
dock yards, This method of fmoothing and
piling the wood is only a late practice ; and
the advantage in point of convenience and
neatnefs feems to be more than overbalanced
by the detriment it thereby receives.

A wet hold difFufes moift vapour all over
the (hip ; and it was a rule with fome of
thofe commanders whom I obferved to be

moft

CHAP. Ir &F DISEASES. 269

raoft fuccefsful in preferving the health of
their men, not only to have daily fires in
the well, but to bail out the water when
the pumps could not exhaufr. it all, and ne-
ver to allow it to collect to more than the
depth of a few inches. It is, therefore,
very doubtful whether it is a good practice
to let in water, as is very commonly done
in order to fweeten the hold, for the fame
fweetnefs will be preferved if it is kept
ftriftly dry. If it mould happen, indeed, that
there mould be a great deal of putrid matter
in the lower parts of the fhip, from previous
negle£t or unavoidable leakage, it may be ad-
vifable to let in a quantity of water in
order to loofen and warn off what is offea-
five, and then to pump it out.

There is a circumftance in the firfr. fitting
out of a fhip well worth attention, as highly
conducive to the drynefs and cleannefs of
the hold. I mean the choice of the baliaft ;
for that which is called Jhingle, confiflingall
of pebbles, is far preferable to that which is
{a.ndy and earthy, as it does not fo readily
foak and retain the moifture and filth. Wa-
ter

fjo cAtisfcs And PKtvtittioit PAkt tU

ter or fluid of any kind readily fubiides in it*
and mould any putrid matter be entangled
in, it, there will be lefs difficulty in warning
it out.

The decks mould not be warned fo often
when the weather is moifr. as when it is
fine, as it will be more difficult to dry them*
and more harm may arife from the moifture
than benefit from the cleannefs* Warning
mould alfo be performed very early in the
morning, even in the befl weather, in order
that there may be time for the decks to be-
come dry in the courfe of the day. It is
after a general warning that the moveable
fires, formerly defcribed, are moil proper
and ufefuh

Every contrivance mould be fallen upon
to change the air in the orlop and hold*
Ventilators and windfalls * are well adapted
for this purpofe, and mould be ufed as fre-
quently and for as long a time as poffible.

* A windfall ir'along cylinder of canvafs, open at both
ends, kept extended with hoops, and long enough to reach
from the lowermoft parts of the fhip through all the hatch-
ways into the open air.

GHAP. I. OF DISEASES. Zjt

It has alfo a good effed in cooling the air in
the lower parts of a fhip in the Weil Indies,
to lift the gratings of the hatches, railing
them on their edges, and lathing them to
the fiaunchions. It contributes likewife to
cleanlinefs and coolnefs to keep the decks as
clear as poflible from chefta and other lum-
ber, which are in the way of fweeping and
warning, and prevent alfo the free courfe
of the air.

Particular attention is neceffary to ventila-
tion in frigates, for almoft all that part in
which the men fleep is excluded from the
air, and they are therefore very uncomfort-
able in the Weft Indies unlefs fmall fcuttles
are cut in the fides. But if this fhould be
objected to as weakening or endangering the
fhip, there is a good contrivance for the fame
purpofe, which I met with on board of the
Nymphe frigate. It confifts of a fquare
wooden pipe, of about nine inches in the
fide coming from between decks, running
along the fide of the fhip, and opening over
the gunwale of the forecaflle. There was
one on each fide.

SECT.

±1% CAUSES AND PREVENTION PART It.

SECT, IV.

Means of guarding againft Infection and
Bad Air*

INFECTION never prevails to fuch a de-
gree, as to affect every perfon indifcriminate*
ly who is expofed to it. Even where the
plague and fmall-pox prevail to the greater!:
degree, there are fome perfons who, though
fufceptible of thefe difeafes, yet efcape them.
There are certain other infections of a weaker
nature, as was before obferved, and thefe
will remain entirely inactive, till they find
conftitutions fo difpofed as to be fit fubjects
-of their action. The feeds of difeafe may
be compared to tbofe of vegetables, which
lye dormant, unlefs they happen to fall into
a fituation peculiarly adapted for exciting
their activity.

There is an endlefs variety in the conrtituJ*-

tion of the human frame, both in mind and

i body,

CftAF. %% 'OP DISEASES, 273

body, as well as in the features of the face.
There are, perhaps^ no two individuals in
the world in whom the fame effect precifely
is produced by the fame food, air, medicine,
poifon, or paflions of the mind. The diffe-
rent effects of infection, therefore^ upon dif-
ferent people, feem to depend in many cafes
on peculiarities of conftitution, too obfcure
to be explained, but there are alfo known
circumftances which refift or encourage its
effects*,

The great power of habit in taking off the
effect of infection, has already been menti-
oned, aiid it would appear that novelty gives
an increafed energy and activity to all im-
preflions, as well as thofe on the fenfes. If
a perfon, therefore, efcapes the firft attack of
infection, he will be more likely to continue
expofed to it with fafety in future.

There are certain precautions neceffary
to be attended to by thofe who are un-
avoidably expofed to contagion, particularly
in the fir ft inftance. Thofe who can afford
a full dietj and a liberal ufe of wine, have

T been

274 CAUSES AND- PREVENTION PART It

been obferved to refill infection better than
thofe who ufe food and drink that is meagre
and watery. It is alfo a good rule not to go
among the fick, nor otherwise to expofe
one's felf to infectious air, with an empty
ftomach ; for whether it is that the body is
then more fufceptible, or that the pores of
the ikin and lungs are in a more highly ab-
forbing ftate, fo as with greater readinefs to
inhale the poifon of difeafe, it is certain that
a perfon in that fituation is more apt to catch
harm from foul air of any kind. Whatever
elfe weakens and exhauils the body, renders
it alfo more fufceptible of noxious impreffions.
Under the head of weakening powers, I com-
prehend not only what empties the body of
its fluids, fuch aslofs of blood, or a diarrhoea,
but intoxication, fatigue, failing, watching,
and certain affections of the mind, fuch as
care and grief.

Cold and moifture may alfo be enumerated
among the caufes that invite the attack of
infectious difeafes. They are of themfeives
limply productive of catarrhs, rheumatifms*
and the like diforders ; but if an infection

mould

1CHAJP. I. OF DISEASE'S, 2^

fhould be accidentally prefent when the body
is expofed to them, then inftead of thefe
complaints, the difeafe peculiar to that in-
fection will be produced *• This was illus-
trated in the laft reinforcement we had from
England ; for while bad fevers were breaking
out in moft of the other mips, the t Union
was affe&ed with thofe complaints only
which are {imply the effects of cold and
moifhire. It would be more proper, per-
haps, to fay* expofure to the air, than to
call it cold', for expoiing the naked body to
the open air, even in the warmefr. climate,
is prejudicial to health.

It is of the greater! confequence to afcer-
tain the extent of the influence of infection,

* It is mentioned by Thucydides, that while the plague
raged at Athens, the people were affe&ed with no other
difeafe, from which it would appear that thofe perfons
who would otherwife have been attacked with fome par-
ticular indifpofition, were feized with the plague in place
of it.

f PartL Book II. Chap. VI.

T 2 for

27$ CAUSES AND PREVENTION- PART it

for the means of avoiding and preventing it
will very much depend upon this. It is
now known, that infection extends itfelf to
a very fmall diftance. There are, indeed,-
fome ^morbid poifons, fuch as that of the
bite of a mad dog, and that of the venereal
difeafe, which require actual contact: to
make them take effect.. Others are more-
volatile, and feem to be in«haled by the
breath, or abforbed by the fkin, but thefe
do not extend far. That of the plague *
does not reach above a few yards, and that
of the fmall- pox- and of fevers is probably
equally limited. This difcovery is very va-
luable, by afcertaining the limits of danger ;
for when a perfon imagines he runs the fame
riik when at a confiderable diltance from the
feat of difeafe, as if he were in contact with
the perfon affected, he will be apt to expofe,
himfelf unneceffarily to the infection.

* It is related by the travellers into Turkey, that the
Chriftians fave themfelves from it, merely fjy fhutting
themfelves up in their houfes, and the inhabitants, who
ileep on the open roofs of the houfes, do not catch it
even from thole of the adjacent buildings, though the wall
that feparates them is of no great heighth.

•CHAP. I. OF DISEASES. 1*77

It feems to be owing to the ignorance of
the extent of its influence, that the plague
has in general been fo fatal ; for in con fre-
quence of the opinion that the whole iur-
rounding atmofphere was affected, it was
•vainly attempted to purify it by large fires
•in the open air, inftead of trulting to the
Reparation of -the *fick, fo as to avoid their
iiear approach, and to the confinement of
thofe who are ki health to their own houfes,
which are all the precautions necefTary to pre-
vent its -progrefs.

There is reafon to think, that the open
air very foon diffipates and renders inert all
infections of the volatile kind, and of courfe
•the warmer the air is the more readily it
will have this effect. It is accordingly ob-
ferved, that infection is much lefs apt to be
•generated about the perfons of men, and that
it adheres to them for a much lefs fpace of
time in a hot climate than in a cold or tem-
perate one. This is a remark., which, fo far
as I know, has not been made by any au-
thor ; and, till obfervation fuggefled it to
me, I fancied the reverfe to be the truth. I
T 3 have

2jZ CAUSES AND IREY-EKTION Jf-ART SS.

have feen fo many inflances of filth and
crowding in mips and hofpitals, in the Weft
Indies, without contagion being produced,
and which in Europe could hardly have
failed to produce it, or to render it more
malignant, that I am convinced there is
fomething in tropical climates unfavourable
to the production and continuance of infec-
tious fevers*. The mips which bring this,
fever from Europe in general get rid of it
foon after arriving in a warm climate; and
nothing but the higheft degree of neglecl*
can continue or revive it.

The fads above mentioned brought into
my mind what is related of the plague at
Smyrna and other places, that it difappears,
at the hotteft part of the year. It is alfo,

* A fa£r, related in Anfon's Voyage, is alfo ftrongly
in proof of the fame opinion. When the rich Spanifri
prize was taken, it was neceflary to crowd the prifoners
into the hold, for fear of an infurreclion, which was to
be dreaded from their number ; yet, when they arrived ra.
China, none of them had died, nor had any difeafe broke
put. They fuffered only in their looks, being wan and
emaciated to a great degree,

curious

CHAP. I. OF DISEASES. 2^9

curious and important to remark, that the
true peftilence never has been heard of be-
tween the tropics. It is not eafy to affign
the caufe of this effecl: of heat upon infec-
tion, as every thing relating to this fubject
as very obfcure. We can conceive it to be
owing to the greater degree of airinefs which
the heat of the climate makes neceffary, or
to the ufe of fewer woollen clothes : there
may be fomething in the {rate of the body,
particularly in the pores of the Ikin, which
difpofes them lefs to imbibe~or produce the
poifonous effluvia ; or more probably, as has
been hinted above, the virulent matter is of
fuch a degree of volatility as to be readily
diffipated in a certain degree of heat *.

There is a fa£t, which, though feemingly
of a contrary tendency, yet is in reality, in
proof of the fame opinion. It is, that thefe

* It may be brought as a farther proof of a warm cli-
mate being unfavourable to every fort of infection, that
though the itch is very common in fhips and hofpitals in
Europe, I do not remember ever to have met with it in
the Weft Indies, except in /hips newly arrived from
England.

T 4 fame

280 CAUSES AND PREVENTION PART If..

fame difeafes difappear in circumftances of
great cold. When England was laft vifited
by the plague, it difappeared in winter ; and
the fame is obferved at Mofcow and other
places. Dr. Guthrie informs us, that infecr.
tion is entangled and fixed by the cold of
winter on the doors and walls of the houfes
of the Ruffian peafants, and that upon the
return of the warm feafon it is let loofe by
the thaw, and then becoming aclive, pro.=
duces difeafes.

With regard to the Weft Indies, the pre-?
cautions that have been laid down are chiefly
neceffary when a fhip newly arrives in the
climate ; for it is during the fir ft three or
four months that ficknefs is apt to prevail.

This does not depend upon any thing pe-
culiar to the climate ; for I have known fhip§
arrive without being vifited with any fick-
nefs. It feems to be owing, for the moft
part, to that (lock of infection and difeafe
imported from Europe exerting its effects,
and when this has fpent itfelf, the men re-
main in good health, unlefs expofed to the

land

CHAP. I. OF DISEASES. 28l

land air or other accidents ; for the air at
fea in thofe climates, as well as every where
elfe, is extremely pyre and wholefome, and
there is no where that feamen are more heal-
thy or -comfortable.

It appeared in the preceding part of this
work, that mofl of the mips of the line
were afTe&ed with a dyfentery foon after ar-
riving in the Weft Indies, This feems to be
the fever of Europe, taking this form fk)m_
the peculiar circumftances of the climate.
The moil common caufes that bring on the
flux are errors in diet, and being expofed
to the air or rain when the body is heated
and under a free perfpiration ; and thefe are
therefore to be particularly avoided upon
£he firft arrival.

CHAR

£%2 CAUSES AND PREVENTION PART II,

CHAP. II.
Of Aliment.

SECT. I. Of Solid Food.

JL HE moll: unnatural circumftance in a
fea life is the food which men ufe, and the
difeafe moft peculiar to it is one which is
owing chiefly to the nature of the aliment ;
for though other caufes confpire in aggrava-
ting the fcurvy, the depraved ftate of the
ingesta is the main and fundamental caufe
of it.

It is this difeafe that is moil fatal to fea-
men next to fevers. It was formerly as fa-
tal, if not more fo ; but fome modern im-
provements have rendered it lefs frequent
and violent. The habitual ufe of fait pro««
vifions, bendes producing evident fymptoms
of fcurvy, begets fuch a ftate of the conftitu-
tion, that, upon the leaf! fcratch being re-

ceived9

CHAP. IX.,' OF DISEASE &» 283

ceived, particularly on the lower extremi-
ties, a large and incurable ulcer enfues ; and
this circumflance, trifling as it appears, is
the caufe of loiing an incredible number of
men to the fervice, efpecially in the Weft
Indies. The greater part of the food of a
{hip's company is necerTarily falted meat.
Bifcuit and peafe, though of a vegetable
nature, are hard of digeftion ; and though
they qualify the animal food, they do not
anfwer the purpofe of frefh vegetables.
Though officers have a fupply of live flock
even for the longer! voyages, it would be
impracticable to carry a quantity fufficient
to preferve a whole crew from the fcurvy.
But certain articles have of late been intro-
duced into ufe, of a durable and portable na-
ture, which fo qualify the fait proviflons,
that they can be ufed without inducing this
difeafe. Thefe are either fuch as are articles
of common diet, viz. melafTes and four
krout, or thofe which are intended only for
the fick and recovering, fuch as portable
foup and the preferved juice of lemons and
oranges.

3;$4 CAt^sES AND PRETENTION PART II.

It is one of the moft ancient and real
grievances in the fervice, that there has not
been a fufficiently ample fupply of nourifh-
ment and cordials for the weak and recover-
ing. This complaint is made by Dr. Cock-
turn, who was phyfician to the fleet in the
end of the lafl century; and it is a complaint
that has not yet been entirely redreffed, nor
has the fubjecl: been confidered with the atten-
tion it deferves. The only improvement in
the fea victualling that I know of from that
time till of late, has been the ufe of raifins
for puddings, and the occaiional ufe of vine-
gar, which is an article extremely falutary,
and was looked upon as the great preferva-
tive of health in the Roman armies.

After the force of difeafe has been fub-
dued at fea, men are frequently loft by re-
lapfes, or pine away in dropfies and other
chronic complaints, for want of being fup-
ported by fome cordial and nourishing diet.
It is mentioned in the memorial to the Ad-
miralty, how inefficient the fmall quantity
of furgeon's necefTaries are ; and it is recom-
mended that a large quantity of certain fpe-
cies of refreshment mould be put in the

purfer's

GHAP. II. Of DISEASES. 2$J

purfer's charge, which, being fubftituted for
the common fea victualling while men are
ill or recovering, would coft Government
little or nothing. Befides the articles al-
ready mentioned, it was recommended to
fet apart a quantity of the beft wines, and
to be provided with brown fugar, dried
fruits, barley, rice, fago, and falep. To
thefe might be added eggs, which, if greafed
and put in fait, may be preferved frem for
any length of time. Carrots and other roots
might alfo be preferved for the longest voy-
ages by means of fugar ; and green vegeta-
bles might in like manner be preferved by
means of fait. But ef all the articles, ei-
ther of medicine or diet, for the cure of the
fcurvy, lemons and oranges* are of much
the greatefr. efficacy. They are real fpeci-
fics in that difeafe, if any thing deferves that
name. This was firft afcertained and fet in
a clear light by Dr. Lind. Upon what
principle their fuperior efficacy depends, and
in what manner they produce their effecl;, I

* Limes, fhaddocks, and perhaps all the other fruits
of that clafs, pofTefs the fame virtues; but I have moll
frequently obferved good efretfts from lemons.

CAUSES AND PRKVENftOtf PAkT Hk

am at a lofs to determine, never having been
able to fatisfy my mind with any theory
concerning the nature and cure of this dif-
eafe, nor hardly indeed of any other. An
ingenious treatife has been publifhed on this
fubject by Dr. Milman, to which I refer the
reader, meaning to confine myfelf in this
work chiefly to what is practical.

Every perfon who has beheld with atten*
tion and feeling, the tedious and languishing
feries of fuffering which the lick and reco-
vering endure for want of the means of fup-
porting and recruiting their fhrength and
fpirits, muft wifh that thofe who prefide
in the civil department of the navy would
feriouily confider this fubject, and complete
the reform that has already been begun.

With regard to the victualling of men in
health, a moil commendable attention has
been paid to the improvement of it. The
ordinary articles of victualling have not only-
been of excellent quality, but fome new ar-
ticles have been added, from which the
greateft benefit has been derived. The

chief

CHAP. II* OF DISEASES. 2$?

chief of thefe. are four krout and melafles.
The latter was firft brought into ufe by-
Lord Howe in the beginning of the late
war. He ordered it to be ferved with rice
to the men, who were affected or threatened
with the fcurvy, in the fquadron under his
command. The fuccefs experienced was fb
great, that during the lafl two years of the
war it was made a regular article of fea vic-
tualling, and fubftituted in place of a cer-
tain proportion of oatmeal *.

* In the courfe of the pafTage from England to the
Weft Indies in February, 1782, the following directions
for ufing the four krout and melafTes were given in pub-
lic orders by the Admiral to the different fhips of the
fquadron :

" The allowance of four krout made by the public
*' boards in England, is two pounds to each man every
" week ; and the Admiral orders that from a pound and
Si a half to two pounds (beginning with the lefler quan-
" tity, and increafing as the men may find it palatable)
" be boiled with every gallon of peafe on a peafe day.
" The cooks are defired not to wafli it, nor to put it
" into the coppers till the peafe are fufficiently broken.
" Half a pound is directed to be iffued raw to each man
" on beef days, and a quarter of a pound on pork days.

" It

288 CAUSES AND PREY INf ION PART lit

As bread is one of the principal articles
of diet, the utmoft care mould be taken in
preferving it, and great advantage would
arife from flowing it in calks that are wa-
ter tight, inftead of keeping it in" bags, or
letting it lie loofe in the bread room. Cap*

** It is recommended that the allowance of vinegar b«
" faved, "particularly on meat days. When four krout
" runs fhort, the peafe and beef days to have the prefer-
" ence ; when fhorter ftill, the peafe days. Melafies
" having been allowed in lieu of part of the oatmeal, iri
" the proportion of eleven pounds to two gallons, the
" Admiral directs, that a pound of melafles be boiled
" with every gallon of oatmeal on Mondays, Wednef-
" days, and Fridays, mixing it and flirring it round
u, with the burgoo immediately after it is drawn off.
" He directs that half a pound of melafles be iffued
" with every three pounds of flour over and above the
" common proportion of raifinsj and to prevent any
" abufe, it is directed that the purfer's Reward pour it
" into the platter with the flour of which the pudding is
" made. The Admiral forbids theufe of peafe in lieu of
" oatmeal, as has fometimes been the practice."

Thefe rules were fuggefied by Sir Charles Douglas,
captain of the fleet, whofe benevolence is equal to his
known profeflional fkiil ; and he had afcertained the uti-
lity of the preceding directions when captain of the
Duke in the former part of the war.

1 tain

CHAP* it. OF DISEASES. 289

tain Cook, by this method, and by giving it
a caft in the oven in the courfe of the voy-
age, preferved his bifcuit round in every re-
flect for more than three years. But the
greatelt improvement in this article of diet
would be to have, in the form of flour* a
greater proportion of what is now allowed
in bread. The flour might be made into pud-
dings, and feems, in this form, to be more
nutritious and antifcorbutic than bifcuit
which has undergone a ftrong force of fire.
This fort of mefs would be ftill more proper
and agreeable now that rneiafTes is a flated
article of diet. Flour, by being well prefled
and rammed, will keep as long as bifcuit ;
it will coll: much lefs in freight than the
fame quantity of It in that form, and it may
be baked abroad if necelfary *. Malt, by
being well rammed, may alfo be preferved for
a great length of time.

Of all the former articles of fea victual-
ling, there was none more abufed than oat-
meal. The quantity allowed to each man
was twice as much as he could confume,

* In the French ftiips of war there is an oven large
enough to fuppiy not only all the officers and fick, but
part of the crew, with foft bread every day.

U and

290 CAUSES AND PREVENTION PART If.

and the overplus went to the purfer's profits,
or was wafted by being given to the hogs,
or even wantonly thrown overboard. Me-
laffes have, with great advantage, been fub-
ftituted for part of it, in the proportion of
eleven pounds for two gallons of oatmeal.
The firft trial of melanes was in the *Fou-
droyant, and it anfwered fo well, that in a
cruife under Admiral Geary in 1780, this
was the only fhip free from the fcurvy, and
out of 2400 men that were landed at the hof-
pital with this difeafe, there were none from
this fhip. It appears to be fo fimilar in its
nature and effects to effence of malt, that it
feems hardly worth while for Government
to be at the expence of providing the latter.

A certain proportion of barley has alfo of
late been fubftituted for part of the oatmeal,
which being more light and palatable, makes
a pleafmg variety, particularly to the lick
and recovering. Captain Cook carried wheat
with him, and found it to anfwer equally
well. Might not potatoes alfo be a proper

* Mr. Napeane, afterwards Under Secretary of State,
was at that time purfer of the Foudroyanr, and acted.
a very benevolent and difinterefted part, by being inftru-
mental in introducing this reform in the aavy victualling.

and

CHAP. II. OF DISEASES. 29I

and falutary fubfHtute, as they will keep a
confiderable length of time in a warm cli-
mate, -and they have been fuccefsfully em*
ployed in their raw ftate for the cure of
fcurvy ? It would not be right, however, to
abolifh oatmeal entirely ; for there is a cer-
tain preparation of it which is an antifcorbu-
tic of equal efficacy with any whatever, ex-
cept the juice of lemons and oranges. This
is flummery, or fowins, which is prepared by
letting oatmeal and water fland together till
they grow acidulous, and then boiling them
into a jelly. I know of fome well-attefled
inftances of the crews of mips being faved
from the fcurvy by this alone.

Butter is a good article of victualling in
fo far as it renders that part of the diet
which confifts of grain and vegetables, more
palatable, and thereby induces men to eat
more. But as it is extremely corruptible in
a warm climate, hardly any being ufed by
the feamen but what is more or lefs rancid,
it mould never be fent to a tropical ftation.
Greater quantities of it are condemned than
of any other article of victualling, and it is
therefore the mofb expenfive to Government.
U 2 There

292 CAUSES AND PREVENTION PART IL

There are certain articles that'are the natu-
ral produce of the Weft-India iflands, which
may he fubdituted for it with the greatefl: ad-
vantage. Thefe are fugar and cocoa*, which,
during the laft year of the war, were ferved
in place of butter with great fuccefs, and
this proved an alteration in diet not only
falutary, but agreeable to the feamen, whole
inclinations are always to be confulted in
fuch changes f.

When

* Half a pound of cocoa, and as much fugar; was al-
lowed in place of a pound of butter.

•f TABLE, exhibiting the daily Allowance of Provi-
fions for each Man in the Navy.

'3
lbs.

rct

1-,

4-1

galls.

lbs.

Pint.

ozs.

Sunday -

half

Monday - -

1
1

Tuefday - -

Wednefday -

half

Thurfday

1
1

half

. Friday - -

half

Saturday - -

1
1 J z

This

CHAP. II. OF DISEASES. SOJ

When a fhip is in port, encouragement
fhould be given to the fale of roots, greens,
fruits, and fugar. The men have a good
cuitom of exchanging part of their bread,
beef, and pork for what they can get from
the more ; but as they in general prefer fpi-
rituous liquors to the above-mentioned arti-
cles, the greatefr. care and vigilance fhould
be uied to preclude men from fuch oppor-
tunities of injuring themfelves *. Every
fhip fhould be furnifhed with a feine, and
other implements for fifliing, when in har-
bour.

When

This has continued from the lafl century till the alte-
rations above mentioned, all of which, except the intro-
duction of vinegar, have been made in the three lafl
years of this war. When the ftock of fmall beer is ex-
hausted, half a pint of fpirits is allowed daily, diluted with
four or five times its quantity of water. When wine is
fupplied, the daily allowance of it to a man is one pint.

* Inftead of leaving this to the management of the
men themfelves, it might be done with greater advantage
to them by militating fhort allowance in the following
manner: — Let a certain proportion, fuppofe one third,
of the fait provifions, bread, and peafe, particularly the
firft, be flopped, and let the amount of this for the whole

U 3 crew

294 CAUSES AND PREVENTION PART II.

When captures are made in which there
are fuch articles as fugar, wine, rice, or
fruits, it would be much better in many-
cafes to allow the immediate ufe of them at
fea, where the men may be difpofed to
fcurvy or other difeafes, than to wait for
the converfion of them into money.

Though it has been my object to intro-
duce as many articles of diet as poffible, in-
dependent of fait provifions, it does not fol-
low that thefe are in themfelves unwhole-
fome. They are pernicious by being made
almoft the fole and exclufive article ; but if
ufed in moderate quantity, they are even in
fome refpe£ls well adapted for the food of
feamen. The nature of their life gives them
a ftrong digeftion : in their duties they not

crew be thrown into one eftimate. Let the agent vic-
tualler pay into the purfer's hands the. value of thefe
provifions in money, at the contract price, with fuch a
difcount as will allow for the ufe of the money. Let
the purfer in return give him a receipt, as if for fo much
prcWilions checked. This money being diftributed in the
name of fhort allowance, will enable the men topurchafe
vegetables, and the provifions will be faved for a time of
want, or for a cruife,

only

CKAP. II. OF DISEASES. 29$

only employ violent exercife* but ufe more
mufcles and a greater variety of poftures
and motions than men of any other profef-
fions. To fuch con ftitut ions may not food
of a refractory nature and hard of digefrion
have even an advantage over what is more
delicate and digeftible ?

I am of opinion, that it is not the fait qua-
lity of the provisions ufed at fea that makes
them productive of fcurvy, but the want of
their native juices and of the nutritious prin-
ciple. A fmall quantity of fait is neeefTary
to make all food palatable and wholefome, in
fo much as to make it be reckoned one of
the neceflaries of life. All animals have a
craving for fea fait, and nature has kindly
made it the mofl abundant and univerfal of
all faline bodies. Food without this feafon-
iflg not only comes to be loathed, but the
want of it renders the animal weak and
flabby. As it not only affifts digeflion,
but invigorates all the bodily functions by
Simulating and bracing the fibres, it is in
fome cafes a valuable medicine. It is re-
U 4 markable

296 CAUSES AND PREVENTION PART II.

markable that men are very apt to tire of a
long continuance of f frefh provifions, but
never of what is fait ; and even under the
fcurvy the latter will be reliflied, and fome-
times preferred to moil other kinds of food.
It has been a practice with fome to make
the fcorbutic men drink fea water; but
though it is not attended with any manifeft
benefit, I never heard that it aggravated the
difeafe.

I was told by the gentlemen of the army
at New York in 1780, that the foldiers in
cantonments were not near fo fubjecT: to
agues as the people of the country ; and the
only difference in their mode of life was-, that
the former had in their allowance a certain
proportion of fait provifions.

In an unhealthy country I mould think a
free ufe of fait, as well as fpice, would be

* The failors in the fquadron of Commodore Anfon
never murmured more under any of their hardfhips than
when they were fed with frefh turtle for a length of time
in the South Sea.

falutary ;

CHAP. II. OF DISEASES. 297

falutary ; and when (hips are in port it would
perhaps be better to allow a certain propor-
tion of fait provifions, becaufe it would not
only be wholefome and agreeable, but the
men's conftitutions would probably be more
reconciled to an entire fait diet when necef-
fary : but I would except from this the
crews of fuch fhips as have newly arrived
from a long cruife or voyage, in which it
may be neceffary to alter the conilitution as
quickly as poffible by a diet entirely fre(h.

Nothing that I have collected from my
own obfervation, or that of others, has been
neglected under this head, except one parti-
cular caution, with regard to the prepara-
tion of the victuals. The large utenfils em-
ployed to boil the provifions are made of
copper, and it fometimes happens from neg-
lect that thefe are allowed to contract a ruit,
which is one of the molt, active poifons we
know. The neglect confifts chiefly in al-
lowing any thing acid, or what is liable to
become acid, fuch as gruel or burgoo, to re-
main for a length of time without being

warned
Z

E^S CAUSES AND PREVENTION- PART II,

wafhed out ; for when victuals have been
prepared in the boilers thus uncleaned, they
produce the moil violent effects, even to the
lofs of life, as once happened in a fhip be-
longing to our fleet *,

* This accident happened in the Cyclops frigate in
September, 1780. Mr. Gordon, the furgeon, favoured
me with the following account of it :

" Mr. Smith, an officer ; John Barber ami Anthony
** Wright, feamen, having eat fome victuals prepared in
**■ a foul copper, complained foon after of violent gripes,
" giddinefs, and vomiting, and they had a few loofe
*' ftools. There was intenfe heat; the pulfe was quick,
" full, and hard ; a tremor of the hands and tongue, and
•* wildnefs of the eyes. The loofenefs was foon fucceed-
** ed by obflinate coftivenefs, tenfion of the abdomen,
" difficult breathing, and lofs of deglutition. In the
** night, towards the morning, there came on infenflbi-
a lity, with an increafe of all the fymptoms, except the
*' heat. The body was violently convulfed, with cold
" clammy fweats and coldnefs of the extremities. The
" abdomen fubfided a fhort time before they died, and,
** before they expired, a fmall quantity of greenifh mat-
*♦ ter, mised with phlegm, hTued from two of their
H, mouths*

" Thirty-three other men were put upon the fick lift
" with fimilar fymptoms in a lefs degree, and fome of

" them

CHAP. II. OF DISEASES, 299

" them continued on the lift for five or fix weeks before
if they perfectly recovered."

It is not faid what means were attempted for the reco-
very of thefe men ; but, befides emetics and milk, or oil,
a dilute folution of the fixed alkali in water has been re-
commended againft this poifon,

SECT.

3pO CAUSES AND PREVENTION PART II,

SECT. II. Of Drink.

A S the folid part of fea diet is very dry
and bard, and as the fait it contains is apt
to excite thirft, a freer ufe of liquids than
at land is neceffary, particularly in a hot
climate.

It has been the cuftom, as far back as we
know, to allow feamen the ufe of fome fort
of fermented liquor. We need hardly in-
quire if this is falutary or not ; for it would
be impoffible at any rate to withhold it,
Jince it is an article of luxury, and a gratifi-
cation which the men would claim as their
right. There is a great propenfity in fea-
men to intoxicating liquors, which is proba-
bly owing to the hardships they undergo,
and to the variety and irregularity of a fea
life. But there is reafon to think that all
forts of fermented liquors, except diftilled
fpirits, are conducive to health at fea.

There

CHAP. II. OF DISEASES. 3OI

There is no doubt that malt liquor is ex-
tremely wholefome and antifcorbutic. The
common quantity of fmall beer allowed
daily is fo liberal, that few men make ufe of
their whole allowance ; and there is no ob-
jection to the conftant ufe of it, except that
it is apt to fpoil in the courfe of a few weeks,
and that upon foreign ftations the flock can
feldom be renewed. One of the greatefl:
improvements that could be made in th&
victualling of the navy would be the intro-
duction of * porter, which can be preferved
in any climate for any length of time that
may be neceffary.

Spruce beer feems to poffefs fimilar and
equal virtues with malt liquor ; and it has

this

* I was furnifhed by Dr, Clephane, phyfician to the
fleet at New York, with the following fa6t, as a ftrong
proof of the excellence of this liquor.

In the beginning of the war two flore fhips, called the
Tortoife and Grampus, failed for America under the con->
vcy of the Daedalus frigate. The Grampus happened to
be fupplied with a fufficient quantity of porter to ferve
the whole pafTage, which proved very long. The other

two

302 CAUSES AND PREVENTION PART II,

this advantage, that the materials of it can
at all times be carried about and ufed occa-
fionally. It agrees with malt liquor in being
a fermented vegetable fweet, the principal
Ingredient of it. being melaffes. The other
ingredient, from which it takes its name,
being a balfamic fubftance, feems to be more
medicinal and antifcorbutic than hops, and
Is therefore, perhaps, preferable to malt li-
quor. There have been fufficient proofs of
its virtues in fingle mips ; and all the men
of war that go to America and the Weft
Indies might be conveniently fupplied with
it. Admiral Pigot provided a fufficient
quantity for the whole fleet ; but the peace
coming on prevented the trial of it.

The moft falutary kind of drink next to
malt liquor and fpruce beer, is wine. The

two mips were furniihed with the common allowance of
fpirits. The weather being unfavourable, the paffage
drew out to fourteen weeks, and, upon their arrival at
New York, the Dsedalus fent to the hofpital a hundred
and twelve men ; the Tortoife fixty-two ; the greater
part of whom were in the laft ftage of the fcurvy. The
Grampus fent only thirteen, ftone of whom had the
fcurvy.

benefit

CHAP. II. OF DISEASES. JOJ

benefit which the fleet derived from it at dif-
ferent times, and the advantage it has over
fpirits, has been often taken notice of in
the former part of this work. It feems t®
be owing to this that the French fleet fome-
times enjoys fuperior health to ours, and is
lefs fubject to the fcurvy *. Wine is alfo
preferable to every other medicine in that
low fever with which (hips are fo much in-
fefted ; tmd there is no cordial equal to good
wine in recruiting men who are recovering.

Spirits differ from wine in this refpec%
that they are a mere chemical liquor, inca-
pable of affimilation with our fluids, ha-
ving loft in diftillation the native vegetable
principle in which the whole of its nu-
tritious quality and great part of its medical
virtue reiides.

* We have a remarkable proof of this in comparing
the fleet under the command of Admiral Byron with that
under the Count D'Eftaing, when they both arrived
from Europe on the coaft of America in the year 1J78,
fome of the Britifh fhips having been unferviceable from
-the uncommon prevalence of fcurvy, while the French
were not affected with it.

Th«

304 CAUSES AND PREVENTION PART II,

The abufe of fpirituous liquors is ex-
tremely pernicious'every where, both as aa
interruption to duty and as it is injurious to
health. It is particularly fo in the Weft
Indies, both becaufe the rum is of a bad
and unwholefome quality, and becaufe this
fpecies of debauchery is more hurtful in a
hot than in a cold climate.

It is with reafon that the new rum is ac-
cufed of being more unwholefome" than
what is old ; for, being long kept, it not
only becomes weaker and more mellow by
part of the fpirit exhaling, but time is al-
lowed for the evaporation of a certain nau-
feous empyreumatic principle, very ofFenfive
to the ftomach, which comes over in the
diftillation ; therefore, though this is the
produce of the Weft-India iflands, yet what
is fupplied there is inferior to that which is
brought from England.

It was originally the cuftom to ferve fea-
men with their allowance of fpirits undi-
luted. The method now in ufe of adding
water to it, was firft introduced by Admiral

Vernon

CHAP. II. OF DISEASES* 305

Vernon in the year 1740, and got the name
of grog* This was a great improvement ;
for the quantity of half a pint, which is
the daily legal allowance to each man, will
intoxicate moil: people to a confiderable de-
gree, if taken at once in a pure ftate.

The fuperiority of wine over fpirits in
any mape was fo confpicuous, that towards
the end of the war the fleets in the Wefr,
Indies and North America were fupplied
with nothing but wine, and with a fuccefs
fufficient to encourage the continuance of
the fame practice in future.

Of Wate a.

As water is a neceffary of life, and as the
health and comfort of men at fea depend
upon its quality, it deferves particular at-
tention.

Spring water is to be preferred to running

water, as the latter is apt to be impregnated

with decayed vegetable and animal fub-

X fiances,

pm CAUSES AND PRETENTION PART i\,

fiances, fuch as leaves, graf?, wood, and
dead infects. This inconvenience is greatefl
in a hot climate ; for there every thing
teems with life, and the materials of putre-
faction are both more abundant and more
prone to corruption. This is the moil per-
nicious kind of impurity ; for the mineral
impregnations common in- fprings are fel-
dom in any degree unwholefome, and do-
not tend like the other to make the water
eorrupt.

The purefl: water is apt to fpoil by produ-
cing a putrid glare upon the inner furface
of the cafk which contains it. There is a
great difference in this refpect between a
new cafk, efpecially if made of moifr. woody
and that cafk which has been hardened and
feafoned by age and ufe. Several contri-
vances have been propofed for preparing the
veffels that hold the water ; but none have
been found by experience fo effectual as fil-
ling them for fome time with fea water ;
and another great advantage of this method
%, its being fo eafily practicable*

It is in few places we meet with water
fuch as that of Briftol, which, in clean vef-
fels, may be kept for any length of time.
We may confider all water kept in wooden
veffels as more or lefs liable to putrefaction ;
but there is a fubftance which is neither rare
nor coftly, and which effectually prefer ves
water fweet. This is quick lime, with
which every fhip mould be provided, in
order to put a pint of it into each butt when
it is filled. It has the advantage of not be-
ing injurious to health ; but, on the con-
trary, is rather friendly to the bowels, tend-
ing to prevent and check fluxes. In the
year 1779 feveral fhips of the line arrived in
the Well: Indies from England, and they
were all afflicted with the flux, except the
Stirling Caftle, which was the only fhip in
which quick lime was put into the water.
Nor does it fpoil the water for any culinary
purpofe. Its action in preventing putrefac-
tion confifts, in part at leaf!:, in deftroying
vegetable and animal life. An addition of
putrefcent matter is produced in water by
the generation of fmall infects ; and the glare
that collects on the fides of cafks; as alfo what
X z collects

3^8 CAUSES AND PREVENTION fART II.

Collects on the furface of the water, is a
fpecies of vegetation of the order called by
naturalifts alga*. Quick lime is a poifon to
this fpecies of vegetable life as well as to
infects. But upon whatever principle it de-
pends, the property of it in preferving water
fweet is fo well afcertained, that it is inex-
cufable ever to neglect the ufe of it.

Quick lime is equally efficacious for this
purpofe, whether flacked or unflacked ; and
though the latter form is more convenient
for flowage, by having lefs weight and
bulk, yet the other is to be preferred for the
fake of fafety ; for if water mould by chance
reach the unflacked lime, a great degree of
heat is thereby produced, which has been
known to give occafion to the moil formi-
dable accidents.

The only other objection I know of to
the ufe of quick lime is, that it converts
the water into a lime-water, rendering it
thereby difagreeable to the palate and jfto-

* See an article in Rozier's Journal de Medicine for
July, 1784, by Dr. Ingenhoufz.

mach :

CHAP. II. O? DISEASES. 3O9

mach : but the quantity neceffary to pre-
ferve it, makes but a very weak lime-wa-
ter ; for part of the lime is precipitated by
the mephitic air, or the aerial acid, as it is
otherwife called, of which there is fome
contained in the water. The accidental ex-,
pofure to the atmofphere, which alfo abounds
with this fort of air, tends farther to leilen.
the acrimony derived from the quick lime*.

There are other fubftances which have
been found ufeful in correcling bad water.
Alum and cream of tartar, as antifeptic

* Since I came to England I have met with a pam-
phlet by Mr. Henry of Manchefler, in which an ingeni-
ous method, founded on chemical principles, is propofed
for feparating the quick lime from water • but 1 fc:ar it is
too nice and complex to be brought into common prac-
tice. It would certainly be worth the trouble ; but
there are fo many duties in a fhip of war to call off the
attention of the men, and they are fo little accufto.med to
nice operations, that it would be difficult to perfuade offi-
cers to attend to it and enforce it. If a fufficient quan-
tity mould not be precipitated by the air in the water,
and by the accidental expofure to the atmofphere, it
might be more effectually expofed to the air by Ofbridge's
machine, to be defcribed hereafter, and if a final 1 imuresr-

I O

nation mould be left, this is rather to be defired than
avoided.

A 3 bodies,

310 CAUSES AND PREVENTION PART IK

bodies, have been employed for this pur-
pofe. Vinegar and the vegetable acid juices
and fruits, fuch as tamarinds, may be ufed
occafionally to take off the putrid offenfive
tafte which may have arifen in cafe the ufe
of quick lime has been neglected. In the
fleet under Sir Charles Saunders, the water
of the river St. Lawrence having been found
to produce fluxes, this quality was removed
by throwing four pounds of burnt bifcuit
into each caik before it was ufed. But there
is nothing fo effectual, and fubjecl: to fo few
inconveniences, as quick lime.

The next method to be mentioned of pu«
rffying water, is filtration, which not only
feparates the grofs impurities, but removes
the putrid fmell and tafte, It is performed
with a dripping {lone, which is a convenient
contrivance for officers, but cannot furnifh
a fupply for a whole fhip's company,

When the water of wells or brooks is
found loaded with mud, the following ex-?
peditious method of filtration, defcribed by
Dr. kind, has been pra&ifed with fuccefs :

— Let

— Let a quantity of clean fand or gravel be
put Into a barrel placed on one end, without
the head, fo as to fill one half or more
of it, and let another barrel, with both ends
knocked out, of a much fmaller fize, (or
let it be an open cylinder of any kind) be
placed erect in the middle of it, and almofl
filled with fand or gravel. If the impure
water be poured into the fmall barrel or
cylinder, it will rife up through the fand
of both barrels, and appear pure above the
fand of the large one in the interval be-
tween it and the fmall one.

But when water is offend ve in confequence
of being long kept, the moit effectual and
expeditious method of fweetening it is by
expofing it to the air in as divided a flate as
pollible. Boiling will not expel the putrid
effluvia contained in water ; but fuch is the
attraction of air for this offenlive matter,
that the water need only be thoroughly ex-
pofed to it to be rendered quite fweet. This
is befl: done by a machine invented by Mr.
Olbridge, a lieutenant of the navy. It con-
fvfts of a hand pump, which is inferted in a
X 4 fcuttle

$12 CAUSES AND PREVENTION PART if.

fcuttle made at the top of a calk, and by
means of it the water, being raifed a few-
feet, falls through feveral meets of tin pier-
ced like cullenders, and placed horizon tally-
in a half-cylinder of the fame metal. The
purpofe of it is to reduce the water into
numberle'fs drops, which being expofed in
this form to the open air, is deprived of its
offenfive quality. The fame method will
ferve to feparate the fuperfluous quick lime
in the water. It is a machine very deferv-
edly in common ufe, and the working it is
a moderate and falutary exercife to men hi
fair weather.

The following contrivance will be found
to afford a fufficient fupply o£ fweet water
to particular mefles, and may be confidered
as an artificial and more expeditious fort of
dripping ftone : — Let the narrow mouth of
a large funnel be filled with a bit of fponge,
Over which let there be a layer of clean gra-
vel or fand covered with a piece of flannel,
and over the whole, another layer of fand.
Muddy or offenfive water being poured upon
f:his, runs or drops out clear ; and care mufr.

CHAP. II. OF DISEASES. 3*3

be taken to change the fand, fponge, &c.
frequently, as they will become loaded with
the impurities of the water *.

There fhould be in every fhip an appara-
tus for drilling water in cafe of diftrefs.
This conufts merely of a head and worm
adapted to the common boiler, and diftilla-
tion may go on while the victuals are boil-
ing. More than eight gallons of excellent
frem water may be drawn off in an hour
from the copper of the fmalleit, fhip of
war f. I refer for a more particular account

* See Dr. Lind on the Health of Seamen,

f The want of this apparatus may be fupplied, in cafe
of exigency, by a contrivance mentioned by Dr, Lind,
eonfifting of a tea-kettle with the handle taken off, and
inverted upon the boiler with a gun barrel adapted to the
fpout, paffing through a barrel of water by way of refri-
geratory, or kept conftantly moifl with a mop.

In this place I cannot help mentioning alfo, that in cafe
of great extremity it has been found that the blood may be
diluted, and thirft removed, by wetting the furface of the
body even with fea water, the vapour of which is always
frefh, and is inhaled by thofe pores of the ikin whole
natural function it is to imbibe moiflure, of which there
is always more or lefs in the common air of the atmof-
phere.

314 CAUSES- AND . PREVENTION PART II.

of all this to the works of Dr. Lind, who
was the original inventor and recommender
of this method.

This invention feems to have efcaped
others fo long, from the idea that the defi-*
deraiurn in frefhening fea water was fome
fubftance to be added to it while under dif-
tillation. No fuch fubftance is neceflary,
and the more fimple the mode of diftilla-
jtibff, the frefher the water will prove.

Rain water at fea is always pure and
wholefome, and may be faved occalionally
by means of a fail or awning.

CHAP.

CHAP. III. OF DISEASE'S* £1$

CHAP. III.
Of Clothing.

JN ATURE has made man fb defencelefs,
that even the rudeft nations, in the hotteft
climates, in general, adopt fome fort of co-
vering to guard themfelves from the wea-
ther. We may affirm, that clothing is the
moll: artificial circumftance in the life of
man ; and there is none, of which the
errors fubject him to more inconvenience
and hardship. Infenfible perfpiration is per-
formed by the pores of the ikin, and being
one of the moft important functions of the
body, the fuppreffion of it feems to be one
of the principal caufes, or at lead one of
the moft frequent attendants on feverifh and
inflammatory complaints ; and one of the
moft common caufes of this fuppreiiion is
the application of cold to the ikin.

In order to keep up perfpiration , It is ne-
ceflary that the orifices of the pores of the

Ikin

316 CAUSES AND PREVENTION frART II,

fkiti (hould be bathed, as it were, in the va-
pour already fecreted from them ; and clo-
thing Teems to a£t in confining this, as well.
as in preventing the efcape of the natural
heat and the accefs of the extern al air.
Though the air mould not be cold, it will
check perfpiration by carrying off this va-
pour and drying the ikin. In the warmed:
climates expofure of the ikin to the external
air is unfafe ; for it not only produces a
feverifh and uneafy fenfation at the time,
but occafions the mofl dangerous internal
diforders. In confequence of the great fen-
fibility and fympathy of the body, and from
the pores of the (kin being open in a warm
climate, expofure is in fbme refpedls even
more dangerous than in a cold one. Nor-
thing is more apt to bring on the locked
jaw and tetanus than deeping in the open
air ; and it was obferved in Jamaica, that
when it was the cuftom to wear cotton and
linen clothes, the dry belly-ache was much
more common than now that it is the cuf?
torn to wear woollen cloth.

{WAP. Ill* OF DISEASES, 317

We know befides, that the pores of the
fkin can abforb not only the moifture that
floats in the atmofphere, but a variety of
foreign bodies, whether noxious or medici-
nal, which may be applied to their orifices ;
and. as the air is in certain places loaded
with noxious matter, may not clothing be
coniidered as a filter, as it were, to feparate
the impurities of the air before it comes in
contact with the furface of the body ?

It is therefore every where of the utmoft
confequence that fufficient and fuitable clo-
thing mould be provided.

It would certainly be for the benefit of
the fervice that an uniform mould be efta-
blifhed for the common men as well as for
the officers. This would oblige them at all
times to have in their pofTeftion a quantity
of decent apparel, fubjecl: to the infpe&ion
of their fuperiors. It would alfo be lefs ealy
to difpofe of their clothes for money with-
out detection, and defertion would alfo
thereby be rendered more difficult,

3*§ CAUSES AND PREVENTION PART II.

It is of great confequence that the purfer
fhould lay in a fufficient flock of clothing
and bedding Anted to the climate for which
the fhip Is deitined, in order that there may
be a fufficient fupply after having been on a
diftant ftation for a certain length of time*
I have known men fufFer the greatest incon-
venience and hardmip, and infectious dif-
eafes kept up, from the neglect of this.

The greatefl evil connected with clothing
is the infection generated by wearing it too
long without fhifting ; for to this caufe we
have afcribed the jail, hofpital, or fhip fever.
The great importance of cleanlinefs appeared
when we were treating of infection, from
■whence we may judge of what confequence
it is that men mould be provided with a
fhift of linen, as that part of the clothing
in contact with the fkin is mofr. likely to
harbour infection *.

,* When we confider that linen was not in ufe
among the ancient Romans, we might be apt to wonder
that they were not more unhealthy j but their fubftitute
for this was frequent bathing, which not only ferved

€«AP. III-. OF DISEASES. 319

As clothing is not the gift of nature,
being left to man's own reafon, it is fubject
to caprice, and thereby productive of incon-
venience and difeafe. The neceffity of it
depends very much upon habit, like every
thing elfe relating to the human body, and
therefore fudden and imfeafonable changes
of apparel are very unfafe to health. It is
alfo found that a partial expofure of the
body is more pernicious than a general ex-
pofure. If I were writing for the more de-
licate part of the world, I mould illuftrate
this by the danger of expofing the feet alone
to cold or wet. It is feldom that feameft
are fo fufceptible, for their hardy and ex-
pofed life fleels them againft fuch impre£«
lions. But there is another eircumftance
which renders it of the utmoir confequenee
to defend the feet againft external injury.
It frequently happens, that, without any

to remove the fordes adhering to the furface of the bodr*
but to air that part of the clothing which was ufually in
contadt with the fkin. The warning of the bodies of
men fufpe&ed of infeftion upon their firft entrance into
a fhip, has already been mentioned, and I have known
fome commanders who made their men frequently bathe
tbemfelvfs, with great feeming advantage.

viiible

320 CAUSES AND PREVENTION PART II.

vifible fymptoms of fcurvy, the conftitu-
tions of feamen are fuch, that upon the
leaft fcratch being received on the feet or
legs, a large fpreading incurable ulcer arifes,
which fometimes ends in the lofs of a limb;
but at any rate difables them from duty till
a cure can be effected by the ufe of a frefh
and vegetable diet, or a change of climate.
Next to acute difeafes and fcurvy this is the
moft deftructive complaint incident to a fea
fife, particularly in a hot climate ; and I
have known great numbers of good men
loft thereby to the fervice. It is therefore
of the utmoft confequence that men fhould
not only be fupplied with fhoes, but be
obliged to wear them, which is found to
require a degree of compulsion ; for in the
Weft Indies it is obferved, that feamen al-
ways wifh to go barefooted.

CHAP,

3hap. w- of diseases. 3!>f

CHAP. IV.
Of Exercise.

A T commonly happens in a fhip of war
that a great proportion of the hands is
landfmen ; for befides the men required to
navigate the fhip, a great number is necef-
fary to fight the guns, as well as for othe*r
duties, and their health may be affected by
the want of exercife.

It has been obferved before, that one ufe
of frequent reviews and mufters in a nume-
rous crew is, to call forth men that would
otherwife be overlooked, to oblige them to
come into the open air, to keep themfelves
clean, and to prevent them from indulging
in filth and lazinefs. It is obferved, that
feamen are in general lefs fubje£l to fcurvy
than marines and landfmen, which feems to
be owing to the greater aftivity of their life
and alacrity of their minds.

Y There

$%2 CAUSES AND PREVENTION PAR.T if.

There are always numbers who have
been prefTed into the fervice, to whom a fea
life is new, and who are therefore prone to
indolence, low fpirits, and felf-negle£t.
Men of this defcription are by far the moil:
apt to fall into the fcurvy ; and next to the
quality of the food, there is nothing con-
tributes more to promote the fcurvy than
fuch a difpofition. It is indeed both a caufe
and a fymptom of this difeafe, and there-
fore idlenefs and Jkulking mould be rigidly
difcouraged, unlefs the complaint is fo far
advanced as to render it cruel and even im-
poflible to force men to take exercife.

There was mentioned in the former part
of this work, an inftance of a fhip in which
only the prime feamen were attacked with
the fcurvy, and it is to be accounted for
upon the fame principle, for it proceeded
from their having been exempted from the
duty of pumping, in which the inferior
claffes of men were conftantly employed?
owing to the leaky ftate of the fhip.

Chap. iv. of diseases* 323

As low fpirits and indolence have fach an
unfavourable effect upon health, it would
be wife as well as benevolent to promote
whatever produces jollity, contentment, and
good humour, fo far as is conliftent with
fobriety and regularity. There are certain
rough fports which are now unfortunately
almoft. in difufe ; and whoever would revive
and encourage them, would perform a ufe-
ful office to the fervice.

A fea - life frequently demands violent
temporary exertions, from the uncertainty of
the weather, and other incidents ; fo that
men are more expofed to extreme fatigue
and fudden calls of duty in this than in any
other fituation of life. Nothing tends more
to fhorten life than exceffive bodily labour
and watching ; and it is for this reafon
that feamen in general are (hort lived, and
that their countenance and general appear-
ance make them appear older than they really
are by feveral years. This is remarkably
the cafe when a fea man comes to be up-
wards of forty ; and it has been mentioned
before, that a perfon not acquainted with
Y 2 this

3^4 CAUSES AND PREVENTION PART ST-

this circumftance will make a miftake of
ten years in gueffing at the age of a feaman
from his looks.

Fatigue being therefore frequently the
means of bringing on difeafe and breaking
the conftitution, as much tendernefs is due
to men as is confiftent with the necefTary
duties of fervice. This is a circumftance in
which young officers are apt to forget them-
felves ; and they mould take care how they
call all hands wantonly, and oblige men to
make exertions beyond their ftrength, efpe-
eially as this will be fubmitted to more rea-
dily by failors than any other fet of men,
from the generous alacrity of their nature.

It would be well if it could be rendered
convenient at all times, except in cafes of
• danger or emergency, to . put the men at
three watches inftead of watch and watch.
By the former arrangement they have eight
hours ileep and reft ; by the latter only four
hours are allowed, which is not fufficient
for refreshment, nor is there time for them

CHAP. TV. OF DISEASES. 325

to get dry, in cafe they have been expofed
to wet.

The good efTedls refuiting from the indul-
gent treatment of men are, that it encou-
rages them to enter into the fervice, and to
do their duty with cheerfulnefs and refolu-
tion. There is fomething more daunting
to the mind of man to fee his companions
fuffering under oppreffion and languifhing
in difeafe, or periming miferably from fores
or ficknefs, than in the terrors of fire and
fword, which, as we have feen, make the
Jeafl part of the calamities of war. The
good treatment of feamen, in fo far as it
regards their health, is by no means incom-
patible with Uriel: difcipline. Indeed ftric~t-
nefs and even feverity is neceflary with
feamen ; for it is obferved with regard to
men who are ufed to arbitrary government,
that they cannot bear indulgence and relax-
ation. But the fteady enforcement of dif-
cipline and regularity is fo far from being
akin to cruelty, that it tends to prevent
both ficknefs and the commifiian of crimes,
Y 3 confe-

326 CAUSES AND PREVENTION PART II.

confequently rendering the infliclion of pu-
nimment lefs frequent and necefTary. The
chief excellence in the character of an
officer feems to con lift in reconciling ftricl
difcipline with indulgence and humanity.

CONCLUSION.

1 HE fubject of the preceding remarks
has been the prevention of difeafe, and it
has appeared that the means of this are not
fo much in the province of the medical pro-
feffion as of thofe who are entrufted with
the direction of the navy in a civil or mili-
tary capacity ; and that with regard to cure
and recovery alfo, a great deal depends upon
them, by their having it in their power to
make a fuitable provifion of proper diet and
cordials. The great importance of the
fubject. will plead my excufe for again cal-
ling to mind, that fuch attentions are not
only dictated by humanity, but would be
the greateft wifdom in an ceconomical and

national

CHAP. IV. OF DISEA8ES. 327

national light, confidering how expeniive
it is to replace men and to fupport invalids,
not to mention that it is upon the health
and lives of men that every public exertion
eflentially depends, and upon which even
the character of officers iu the day of bat-
tle may depend.

It mufl be confefTed, that though there
is {till room for improvement, the navy is
now on a better footing with regard to the
health and comfort of feamen than it ap-
pears to have been in former times. The
victuals were in general in the late war of
excellent quality ; the civil branch has fhewn
in many inftances a readinefs to adopt the
means and to furniih the articles that were
recommended for the health of the men * ;
and moft of the commanders whom I have
the honour to know are humane, attentive,
and intelligent.

To conclude ; there is no fituation of life
in which there is room for more virtues,

* See Part I.

Y 4 more

328 CAUSEI AND PREVENTION PAS.T tti

more conduct and addrefs, than that of a
fea officer. The men are thrown upon his
humanity and attention in more views than
one : they are fubject to a more arbitrary
exertion of power than the conftitution of
the ftate authorifes in civil life, Englishmen
giving up into his hands that which they
hold molt dear, and of which they are moft
jealous, their liberty : it is the character
of feamen to be thoughtlefs and neglectful
of their own intereft and welfare, requiring
to be tended like children ; but from their
bravery, utility, and other good qualities,
they feem entitled to a degree of parental
tendernefs and attention from the ftate they
protect and the officers they obey.

APPENDIX

CHAP. IV? OF DISEASES. ^° 329

APPENDIX to PART II.

In order to exhibit a concife view of the
mofl material obfervations contained ip.
this part of the work, a memorial, deli-
vered to the Board of Admiralty in Octo-
ber, 1 78 1, is here fubjoined,

MEMORIAL,

Proposing Means for preventing the Sicknefs
and Mortality prevailing among His Ma*
jetty's Seamen in the Weft Indies.

J. HAVE for the two laft years attended a
fquadron, confining feldom of lefs than
twenty fhips of the line, in quality of phy-
fician to the fleet at Barbadoes and the Lee-
ward Iilands. I received, by the order of
the Commander in Chief, a monthly return
from the furgeon of each (hip, fetting forth
the difeafes, deaths, and other circum?
ilances of the refpe&ive fhips companies.

1 alio

33° CAUSES AND PREVENTION PART II,

I alfo fuperintended the hofpital of the place
where the fleet happened to lie when in port.
Thefe advantages have afforded me an inti-
mate knowledge of the nature and caufes of
the ficknefs and mortality among the fea-
men, both on board of their fhips and in
hofpitals.

It appears by my returns, that there died
in the courfe of the twelve months prece-
ding July laft, on board of fhips, {even
hundred and fifteen feamen and marines, of
whom only fifty-nine died in battle and of
wounds. There died in the fame time in
hofpitals, eight hundred and fixty-two : fo
that out of twelve thoufand one hundred
and nine men, which is the fum total of the
complement of twenty fhips of the line,
there have perifhed in one year one thoufand
five hundred and feventy - feven, that is
nearly every feventh man.

There were alfo fent to England in the
fame year, three hundred and fifty men,
difabled by lamenefs and chronic complaints,

the

CHAP. IV. OF DISEASES. 33I

the greater part of whom will be for ever
loft to the fervice.

The degree of ficknefs is very different at
different times ; but it appears by the re-
turns, that at a medium there has been one
man in fifteen on the lick lift.

Having employed all the attention of
which I was capable to find out the caufes
of this ficknefs and mortality, in order, if
poflible, to point out the means of preven-
tion, I flatter myfelf with being able to
affign the moft general caufes, and to pro-
pofe fome effectual remedies.

When it is confidered that ficknefs is al-
moft entirely confined to mips of two and
three decks,, and that fome of thefe are as
healthy as frigates and merchant mips,
though in the fame circumftances of fervice
with others that are extremely fickly, we
are led from hence to infer, that ficknefs is
not in its own nature unavoidable, and we
are encouraged to hope, that the attainment

3 of

332 CAUSES AND PREVENTION PART II.

of general health is within the compafs of
human management.

I humbly and earneftly folicit attention
to fome of the mofl material obfervations
and conclufions which have occurred in the
cou.rfe of a fervice, which, though fhort,
has been extenfive ; and whatever I have to
propofe has this recommendation, that it is
eafily practicable, and is no addition to the
public charges.

Firft, I hardly ever knew a fhip's com-
pany become lickly which was well regu-
lated in point of cleanlinefs and drynefs. It
is the cuftom in fome mips to divide the
crew into fquads or divifions under the in-
fpe&ion of refpective officers, who make a
weekly review of their perfons and clothing,
and are anfwerable for the cleanlinefs and
regularity of their feveral allotments. This
ought to be an indifpenfable duty in mips of
two or three decks ; and when it has been
practifed, and at the fame time ventilation,
cleanlinefs, and drynefs below and between
decks have been attended tas I have never

known

CHAP. IV. OF DISEASES. ^$3

known feamen more unhealthy than other
men. The neglect of fuch attentions is a
never-failing caufe of ficknefs.

I would therefore, with all becoming de-
ference, fuggeft, that fuch a regulation, in-
stead of being left to the difcretion of offi-
cers, fhould be made a part of the public
inftructions. From fome commanders, who
already practife thefe rules, the advantage
of them comes to be known ; and would
not a public fanction not only render them
general and permanent, but facilitate the
duty of the officer, by making fuch a regula-
tion appear a matter of legal neceffity inftead
of his own arbitrary act ?

Secondly, Scurvy is one of the principal
difeafes with which feamen are afflicted, and
this may be infallibly prevented, or cured by
vegetables and fruit, particularly oranges, le-
mons, or limes. Thefe might be fupplied
by employing one or more fmall veflels to
collect them at different iflands, and fuch an
expedient would prevent much ficknefs, and
fave many lives. I am well convinced that

534 CAUSES AND PREVENTION PART It.

more men would be faved by fuch a purvey-
ance of fruit and vegetables, than could be
raifed by double the expence and trouble em-
ployed on the imprefr. iervice ; fo that policy,
as well as humanity, concur in recommend*
ing it. Every fifty oranges or lemons might
be confidered as a hand to the fleet, inafmuch
as the health, and perhaps the life of a man
would thereby be faved.

Thirdly, The ufe of wine, in place of
rum, has been found extremely conducive
to health. In the courfe of my obfervation,
I have met with the mofl unqueftionable
proofs of the benefit that would arife from
this fubftitution. . It is a farther reafon for
fuch a change, that good rum is feldom or
never fupplied in the Weft Indies.

Fourthly, the neceffaries provided for the
iick by the prefent eftabliiriment are not at
all adequate, efpecially on a diflant ftation,
where the fupply is not regular, and the
quantity at bell is fuch as can contribute but
little to their comfort and recovery. An
ample provifion might be made for the fick,

without

CHAF. IYM OF DISEASES. 33^

without any additional expence, in the fol-
lowing manner :

It is a rule in the fervice, that though men
are lick, their ordinary allowance of fait meat
and other victuals is nevertheless ferved out,
and is either ufed by the other feamen,
who ftand in no need of it, or is wailed,
Now, if the Purfers were inftru&ed to pro-
vide themfelves with certain fpecies of ne-
cefTaries, fuch as Madeira wine, fugar, rice,
and dried fruits, to ferve to the lick, in place
of rum, and the common provisions of the
ihip, fuch a regulation would be productive
of the very beft effects, in recovering the
health, and preferring the lives of thofe men
who have the misfortune to be taken ill in
a Situation necelfarily deftitute of moil: of
the comforts that can alleviate their fuffer-
ings. I cannot help here applauding a late
regulation, by which melafies are fubftituted
for part of the oatmeal ; for the quantity of
the latter heretofore legally allowed was fo
much greater than what was neceffary, that
one half of it has commonly been wafted.

33^ CAUSES AND PREVENTION VART II,

It is to be obferved, in general, with re-
gard to the Weft Indies, that mips on fer-
vice are to be confidered in a great meafure
in the light of fhips conftantly at fea ; for,
excepting the ifland of Barbadoes, there is
no other port in which frefh meat and vege-
tables can be procured in any quantity, and
therefore four krout, melafles, and fuch
other articles of antifcorbutic diet as can be
fupplied on board, are abfolutely neceflary.
Fleets could hardly exift here, were it not
that a warm climate is naturally more unfa-
vourable to the fcurvy than a cold one.

Fifthly, Though the health of a fhip's
company depends chiefly on diet, and that
difcipline and order which is the bufinefs of
officers, yet much depends alfo on the me-
dical art, particularly in the Weft Indies ;
and as -furgeons frequently cannot do juftice
to the men without wronging themfelves, in
a country where the price of every thing is
exorbitant and medicines often un found,
Government would rind its account in fup-
plying gratuitoufly fome of the moil: coftly

articles,

APPENDIX. OF DISEASES. 337

articles, particularly Peruvian bark in a
frefh flate, from time to time from England,

Sixthly* It is now the general cuftom to
fend every fick perfon on fhore to an hofpital,
where there is frequently worfe air and
worfe accommodation than on board, from
over-crowding the apartments. Contagious
difeafes, though not fo common as in Europe,
are here often mixed with thofe that are not
fo, whereby numbers are infected and car-
ried off; and, befides this, the land air is in-
finitely more unwholefbme in the Well: In-
dies than the air at fea or in a road. The
fcurvy is perhaps not at all contagious, nor is
it very difficult of cure; but a number of cafes
of it terminate fatally from the flux or fever
caught either by contagion in hofpitals, by the
noxious influence of land vapours, or by
intemperance. I beg, therefore, humbly to
fugged, that as few fick as poffible of any
difeafe, but what is contagious, be fent to
hofpitals, and that fome method be eftablifhed
for the fupply of vegetables and other re-*
frefhments to the fick on board of their
fjiips.

Z Seven thlys

33% CAUSES' AND PREVENTION FA&T 12.

Seventhly, Crowding, filth, and the mix*
ture of difeafes, are the great caufes of mor-
tality in hofpitals. There mould be a fpace
of five hundred cubic feet allowed for each
man ; and in general the fick had better re-
main on board than be crowded beyond that
degree ; or relief mould be provided to the
hofpital by an hofpital fhip, which, for rea-
fons already given, is preferable to any ac-
commodation on more ; and fuch an infti-
tution would be more particularly proper
for the reception of convalefcent men.

I would beg leave, therefore, earneflly
to recommend that cleanlinefs, the fe-
paration of difeafes, and a competent fpace,
be regularly enjoined and ftrictly enforced
in liofpitals, and in order to make this more
practicable in the great fcale of fervice now
going on, I would farther propofe that hof-
pital mips be eftablifhed for the reception of
the fick or recovering. I know from exten-.
live experience and clofe obfervation, that
thefe circumftances are more efiential than
even medicine and diet.

Thefs

,AjPPENl3IX* OP DISEASES. 33^

Thefe are a few remarks extra&ed from a
feries of obfervations, and derived from
great opportunities of experience. Many-
other remarks would fuggeft themfelves ; but
I purpofely confine myfelf to what is highly
important, and eafily practicable, with
little or no addition to the public expence.
Some of the improvements recommended
are indeed an immediate, and ail of them
will be an eventual faving to the public.

The alterations that have been propofed
are,

I ft, The eftablifhment of a certain me*
thod and difcipline, in order to fecure regu-
larity and cleanlinefs among the men, and
to render the fhips clean and dry.

2dly, The fupply of fruit and other ve-
getables for the cure of the fcurvy.

3dly, The fubftitution of wine* for rum.

* Had I then known the falutary effects of porter
and fpruce beer, of which I have fince been convinced,
I ihould have propofed them as fubftitutes for rum.

Z z 4thly,

CAUSES AND PREVENTION PART II,

4thly, The provision of an adequate quan-
tity of neceffaries for the fick,

■

5thly, The gratuitous fupply of certain
medicines.

6thly, The curing of certain difeafes on
board inftead of fending them to hofpitals ;
and,

LafUy, The preventing of filth, crowding,
and the mixture of difeafes in hofpitals, by
proper regulations, and by eflablifhing hos-
pital ihips.

I beg leave again to call to mind, that
1 5 1 8 deaths from difeafe, befides 350 inva-
lids, in 12,109 men, in the courfe of one
year, is an alarming wafle of Britifh feamen,
being a number that would man three of
His Majefty's fhips of the line ; and what I
advance is from a real conviction that a due
attention to the above-mentioned propo-
rtions would fave more than two thirds of
the feamen that would otherwife die in that
climate. It was to fet this in a proper light
-" that

APPENDIX. OF DISEASES. 34-1

that I requeued leave to quit my duty during
the abfence of the greater part of the iqua-
dron in the hurricane months; and mould
any thing I propofe meet with public appro-
bation, and be carried into effect, 1 mould
efieem it a recompenee far above any other
gratification I can derive from, the fervice.

London,
Oa. 13, 1 781,

To the Right Hon. the Lords Commiffioners
of the Admiralty.

Next year the following Supplement to
the preceding Memorial was lent to the
Board of Admiralty:

Supplement to the Memorial delivered
laft Year to the Board of Admiralty.

SINGE my return to my duty on this
ftation, additional experience has afforded
Hie farther practical confirmation of the
utility of the former propofals.

Z 3 The

342 CAUSE8 AND PREVENTION TART II,

The great fquadron employed on this itation
has, by the attention of the Com million ers
of Victualling, and alio of the Commander
in Chief, been fupplied with moft of the
articles recommended, in fuch quantities as
to prove their efficacy ; and indeed the fmall
degree of mortality in cemparifon of former
times, is a fufficient demonfrration of this.

I beg leave to give an inftance in the For*
midable of the great and falutary effects of
the propofed improvements. This fhip left
England, furnifhed not only with four krout
and melaffes, in common with moft others
in the fquadron, but what was peculiar to
herfelf was, an entire fupply of good wine
in place of fpirits ; and an experiment has
been made in this inftance, under my own
eye, to afcertain what degree of health it was
poffible to attain in a great fhip in this cli-
mate. With the above advantages, toge*
ther with good difcipline and medical care,
no man* died of difeafe from December,

1781,

* The authenticity of this fa£V, as well as every
other aflertion in this work relating to the mortality

APPENBIX. OF DISEASES. 343

1781, to May, 1782, and only thirteen
were fent to hofpitals, whofe complaints
were fmall-pox and ulcers, hi the months
of May and June laft, when at Jamaica,
there died of difeafe in this fhip, three men,
and {Seventeen were fent to the hofpital,
mofl of whom had contracted their fieknefs
©n board of French prizes.

In the reil: of the fleet the health was in
proportion to the wine and other refresh-
ments, and the cleanlinefs, good order, and
difcipline obferved.

In the fquadron I attended the lafl five
months, which feldom confifted, during
the laft three months of that time, of lefs
than forty fhips of the line, there have died
of difeafe about 350 men, and about 10.00
have been fent to hofpitals ; a degree of fick-
nefs and mortality which, though not
greater than what frequently prevails in
Europe, I am perfuaded would have been

in the fleet, may be proved from the fiiips' books, depo-
iited at the Nayy Office.

Z 4 ftill

344 CAUSES AND PREVENTION PART IX.

fHll lefs, had the improvements propofed
been complied with in a manner more ex*
teniive and complete, and had the general
rules of difcipline and cleanlinefs been kept
tip with due and equal ftri&nefs throughout
the fleet.

This laft article, which, being the moft
important, I have placed firft in the prece-
ding memorial, it is only in the power of
fupreme authority to enforce ; and my addi-
tional experience and obfervation have fo far
confirmed me in the opinion of the utility
of this, as well as the other articles, that I
hope to be again pardoned for repeating my
humble and earnefr. folicitations that thefe
regulations may be farther extended an4
enforced.

Formidable.,

At Port RoyaJ, Jamaica,

July 1 6, 1782.

PART

1 345 1
PART III-

DESCRIPTION AND TREATMENT

Of T HE

DISEASES

most Frequently occurring is

FLEETS IN HOT CLIMATES.

I MENTIONED in the Introduction to
this work, that though my opportunities of
experience were extennve, feveral obftacles
had prevented me from making obfervations
fo accurately as could have been wifhed. Thefe
were chiefly the bad accommodation of the
fick at fome of the hofpitals, and the fhort-
nefs of our fray at any one place, which fel-
dom exceeded fix weeks or two months,
and prevented me from completing fuch
obfervations as I happened to be engaged in.
But having praclifed among great numbers,
obfervations necefTarily arofe from the com-
parifon of fo many cafes ; and amidfl the va-
riety of fituations connected with the emer-
gencies

34-6 OBSERVATIONS PART III.

gencies and hardships of war, nature is feeu
in certain pofitions and under certain trials
which are not met with in common life. I
mall therefore defcribe the difeafes fuch as
they occurred, and mail add fuch remarks
on practice as I could afcertain.

The following obfervations fhall be con*
rlned chiefly to what I have called the fea
epidemics, viz. Fevers, Fluxes, and the

Scurvy.

CHAP,

CHAP. t. ON FEVERS, 347

CHAP. I.
Of Fevers.

X HOUGH it is impoffible to refer every
particular cafe of fever to a diftincl: clafs,
on account of the mixed and anomalous
fymptoms that arife, yet there are certain
difHnguifhing features which afford fufficient
ground for dividing them into different kinds,
and fuch a divifion will at leafb ferve to faci*
litate defcription, and to afford room for lay-
ing down the outlines of practice.

The fevers which occurred moft frequent-
ly on board of fhips, and at naval hofpitals
belonging to the fleet in which I was ems-
ployed, were the infectious fhip fever,
(which is the fame with the jail and hofpir
tal fever) the bilious remitting fever, and
the malignant yellow fever,

1. Of

OBSERVATIONS J>ART HI,

i. Of the infectious Ship Fever.

This does not occur fo frequently in hot
as in cold climates, both becaufe it is the
difeafe of (hips newly fitted out, which they
feldom are in the Weft Indies, and becaufe
there is fomething in the warmth of a cli-
mate which prevents the production of con-
tagion, as has been formerly remarked. But
as great fleets arrived from time to time in
the Weft Indies from Europe, with num-
bers of men labouring under this fever,
there were fufficient opportunities of making
obfervations upon it.

It has been fo well defcribed by Sir John
Pringle, Dr. Lind, and other writers, that
it is unnecerTary to enter into a minute de-
tail of all its different appearances in its
feveral ftages ; and I fhall content myfelf
with recounting fome of the moft diftin-
guiming fymptoms, and with marking the
peculiarities that arofe from the influence of
the climate.

This

eBAp.'t, o-r fetiu. 349

This fever is extremely various in its
fymptoms and in its degree of malignity
and fatality. We are told in fome of the
hiftories of the jail diftemper, that, upon
its iirft attack, few efcaped that were feized
with it ; but that afterwards it grew more
miid ; and it has been already obferved, that
the contagious poifon of fever differs from
that of fmall-pox and other fpecific infec-
tions, by varying in its degrees of viru-
lence.

There are, however, certain characteristic
fymptoms pretty conftant in this fever in all
its forms.

One of the mofl remarkable of thefe is a
greater degree of mufcular debility than what
takes place in other fevers, and it deferves to
be mentioned firfr, as being one of the moil:
conftant. It is alfo a tolerably true index of
the degree of malignity, the danger being
in proportion to this fymptom.

Another ftriking character of this fever is
the delirium of a particular kind which at-
tends

35<5 OBSERVATIONS PART lit*

tends it. Senfation and reafon are here in a
{rate uncommonly depraved ; and it is in
this fort of fever oftener than any other
that we find a total deprivation of them in
the fymptom called coma. The delirium is
feldom of a wild, ungovernable kind, fuch
as occurs in inflammatory, continued fevers,
in the violent paroxyfms of intermitting and
remitting fevers, or in inflammations of
the brain. It is, however, connected with
great fuffering ; and this confifls in anguifh
rather than pain, (hewing itfelf by outward
tremor and agitation, fighing, mumbling,
and moaning, fymptoms always indicating
danger.

Delirium is a fymptom, to the nature and
appearances of which I have been particu-
larly attentive, in confequence of a painful
and diligent attendance upon fome cafes in
which I was particularly interefted from
friendfhip and affection, and in which this
was a remarkable fy mptom. 1 1 feems chiefly
to confifl in a falfe reference of our fenfa-
tions, whether external or internal ; and
this is in no cafes more evident than in this

fort

CHAP. U ON FEVERS. 351

fort of fever. When any painful impref-
fion, for inftance, is made by an external
body, the patient, if in a ftate of delirium,
does not refer it juftly to the part affected ;
but the general agitation and incoherence of
fentiments will be aggravated for the time.
I have known a degree of heat applied to
the extremities fufficient to blifler them,
yet the part did not fhrink, though the ra-
ving and general uneafinefs were increafed.
In like manner, with regard to internal fen^
fations, when an irritation is excited to ex-
pel the urine or feces, the mind does not re-
cognize it as fuch, but from a fenfe of unea-
finefs, probably miftaken for fomething elfe,
an effort is made to relieve nature, which
is done without a proper confeiouinefs, and
certain fymptoms are produced which are
well-known marks of danger in this fever.
In watching thofe who have been under the
influence of delirium, I have obferved it in-
creafe when any particular want of nature
urged, and this would continue for fome
time, the patient being incapable of procu-
ring himfelf immediate relief on account of
the falfe reference of fenfation that has been
1 mentioned :

352 OBSERVATIONS PART III.

mentioned ; but he would become calm af-
ter voiding the urine or feces, or after re-
ceiving fomething to drink, according to the
particular want that was prefent at the time.
So great is the diforder in the common
courfe of fenfation in this fever, that a per-
fon ill of it has been even unconfcious of in-
flammations of vital parts, which, in the na-
tural ftate of the nerves, would have excited
the mod acute pain, and would have been
difr.mcl.ly referred to the part affected, but
were not difcovered nor fufpected till infpec-
tion after death *. I remember one cafe in
which there were found large erofions, and
even holes in the intefHnes, without any

* I fancied that my reafoning on this fubject was in
a great meafure new ; but I lately met with the follow-
ing pafTages in Celfus and Hippocrates, which feem to
be illustrative of the fame idea : Quibus caufa doloris,
neque fenfus ejus eft, his mens laborat. Celfus. Lib. ii.
cap. vii. which is nearly a tranllation of the following
aphorifm of Hippocrates : — 'Oxo<roi wfsom; t» t« cw/*aToj, t«

ttqT&u. rm vrovuv an atcrBxnovra^ rartonrni jj ywym vo<re». HippOC.

Aphor. Lib. ii. Aphor. 6.

The fame principle is ingeniously explained by Mr.
Hunter in his Lectures.

preceding

CHAP. I. 0 N F £ V E & S. g££

preceding complaint that could have led to
fufpecl: fuch an appearance. It would ap-
pear that the motions excited in the brain
and nerves in fuch cafes, inftead of produ-
cing the fenfations naturally belonging to
them, ferve to excite difagreeable emotions
of a different kind, in which delirium con-
lifts. It feems to be from the fame depraved
ftate of fenfation, that when a phthifical
perfon is feized with this fort of fever, his
cough is for the time fufpended. I have feea
the fame circumftance occur in a maniacal
cafe. From a like caufe it fometimes hap-
pens in dangerous cafes of fever, that in the
height of delirium the epiglottis lofes its na-
tural irritability, fo that liquids in the ad of
fwallowing are apt to get into the windpipe,
fb as to excite Coughing and threaten furfo-
Cation, as I have obferved in fome cafes that
came under my care*

All thefe different forms of delirium are
figns of a body extremely difordered in its
functions, and forebode great danger.

The next fymptom I fhall mention as
moil chara&eriftic of this fort of fever is,

A a the

554- OBSERVATIONS PART III,

the fpots known by the name of petechia
and vibices, which, though far from being
conflant, are, perhaps, more peculiar to it
than any other iymptom. They occur only
in the latter ftages of the difeafe, and in
cafes of considerable danger. The common
opinion concerning their caufe is, that the
blood is in fuch a dhTolved date, that the
red part of it is efFufed into the cellular
membrane. The appearance in fuch bodies
as I have infpected, feems to favour this
opinion ; for there was hardly any coagula-
tion of the blood in the great veffels, and
inftead of thofe firm fubftances, called po-
lypi, in the heart, there were only foft
grumous bodies, which were fo tender in
their confiftence, that upon being handled
they, as it were, dhTolved.

It may be considered as a peculiarity of
this fever, that it is more indefinite in its
criiis than moll others. In continued fevers
of the inflammatory kind, there are frequent
attempts at remiffion, there are certain pe-
riodical exacerbations, and there is generally
a diflincl: criiis marked by a freedom of the
fecretions and turbid urine : but in the fever -

C&AP. I. ON FEVERS*.

of which we aire treating, though the pa-
tient is generally fomewhat worfe towards
the evening and dating the night, its courfe
is more equable, and the tranfition from
ficknefs to health is infenfible and gradual,
being feldorri marked with any perceptible
crifis.

*The lymptom next to be taken notice of,
though a minute one, is very conftant and
chara&eriftic in this fort of fever. It is a
peculiar heat in the fkin, communicated to
the hand of another perfon. It is ufual to
grafp the wrift of the patient after feeling
his pulfe, in order to examine the ftate of
the fkin in point of heat and moifture ; and
in doing this a glow of heat is impreffed on
the palm of the hand, which lafts for fome
hours, if one fhould neglecl fo long to wafh
the hands. I have never met with this
iymptom in any of the fporadic fevers of
England, though I am informed it fome-
times occurs in thtfe.

The fever we are treating of differs alfo
from the fporadic nervous fever of Eng-
land, and from moft others of the continued
A a 2 kind,

35$ OBSERVATIONS FART III.

kind, in being attended with a more copi-
ous fecretion of bile, which, when thrown
up, is generally green, or, as it is other-
wife called, of a porraceous colour. This
iymptom takes place in all climates ; but is-
more remarkable in a hot climate, as might
be expected.

Thefe are the chief characteriftic fymp-
toms of this fever. I fhall next point out
fuch modifications of it as occurred in the
Weft Indies from the influence of climate.

In the firft place, when this fever prevail^
ed on board of any fhip that arrived from a
northern climate, it was foon after fucceed-
ed by, or, as it were, converted into, a 6y-
fentery ; for thofe mips that arrived either
from England or North America with
the greateft flock of feverim infection,
were the moft fubject to fluxes, after being
two or three months in the Weft Indies*
This was formerly made ufe of as an argu-?
ment, to prove that the dyfentery proceeds
from the fame caufe with fever, taking a
different determination, from circumftances
of climate and constitution.

Secondly,

<SHAP. I. ON FEVEi S, 357

Secondly, It fometimes happens that
men, under the influence of this infection,
are more apt than others to be affected with
fymptoms peculiar to the climate upon their
firft arrival. A very ftriking inftance of this
has been mentioned in the cafe of men that
were prefTed into the Formidable at New
York, lbme of whom had the common fhip
fever on the paffage ; others, upon our arri-
val at Barbadoes, were feized with the yel-
low fever, and were the only men in the
fleet who had it at that time. There was
another infiance in the recruits brought
from England by the Anfon, who were
feized with a fever on board of the Royal
Oak; and in this fever the fkin and eyes
were yellow, though without any iymp-
£oms of malignancy *.

Thirdly, It happened in fome mips f
that the infection was kept up for feveral
months after arriving in the climate, from a
neglect of cleanlinefs, or the want of an op-
portunity of removing thofe who were in-

* See page 175.

f Seepages 120 and 121.

A a 3 fected

35* O B S E RVATIQNS YART IXI«,

fedted to an hofpital. It did not in thefe
take a dyfenteric turn, as in moft of the
other mips, but differed from the fhip fever
of colder climates, as above defcribed, in
fome particulars, which I fhall here enu-*
merate. All the fymptoms were mjjder:
it was more protracted, and lefs dangerous.
In the beginning there was but little differ
rence, only the fymptoms were lefs violent ;
but in the fucceeding period of the difeafe
the pulfe deviated very little from the natural
ftandard, and the ikin felt cold and clammy.
The tongue was white ; and this did not
feem fo much owing to any fur covering \t,
as to its being itfelf of a pale, lifelefs colour,
as well as the face, and it appeared larger in
iize than natural. The teeth were clogged
with a white fur. Thofe affected with this
fever were fubjecl to faintings, and had a
conftant uncomfortable languor and liitleff-
nefs. Moft of them had a deep-feated pain
in the occiput, and an oppreffion at the
ftomach, but without any inclination to
vomit. The unfavourable fymptoms were
eoma> delirium, and a yellownefs of the Ikin.
J never remember to have feen petechia in

any

CHAP. I. OWPEVERS. "35£

any of them. The favourable fymptoms
were a warm moifture, or ar miliary erupf
tion on the fkin, and a gentle diarrhoea,
which, however, if neglected, was in dan-
ger of degenerating into an incurable flux.
A great number were feized with this fever
in the Alcide, in July, 1 783, and what is
remarkable, mofl of them had the tape
worm, as 1 was informed by Mr. Telford,
the furgeon of that Ihip, who frequently
obliged me with valuable remarks ; and he
obferved alfb, that it was evidently infecti-
ous, and that the ikin communicated the
fame difagreeable feeling to the hand as was
mentioned above.

Though the inflammatory fever does not
often occur in hot climates, yet, as it is of
great confequenee to diftinguim it in all
cafes from the infectious fever of which we
are treating, it may not be improper, nor
uninfiru&ive, here to point out the mofi
remarkable differences. There is more re*
femblance in their fymptoms, efpecially to*
wards the beginning, than might at firit be
fuppofed ; and as it is very material to avoid
A a 4 error

366 OBSERVATIONS 3?ART Ilf.

error with regard to the pra&ice, which, in j
thefe two forts of fevers, ought to be very
different, and even oppolite, I have taken
particular pains to difcriminate them.

The continued inflammatory fever is very
uncommon in the Weft Indies ; but in the
form in which I have met with it in North
America and England, there are cafes in
which the blood is fizy during the whole
courfe of the difeafe, even without local
affection ; though in general there is more
or lefs rheumatifm, or pulmonic inflam*
mation. The fymptoms which chiefly dif-
tinguifh fuch cafes from the fever before
defcribed are, a greater degree of muf-
cnlar ftrength, a more violent delirium,
pale urine, a more^ parched tongue and
fkin, greater heat and thirft, and a pulfe
more frequent and ftrong, with a particular
fharpneis. There is another fyrnptom fome-
times occurring, which I confider as ftrong-
Jy character! (lie of a fever of an inflamma-
tory nature. This is1 a watery diarrhoea,
■without f^ces and without gripes, the ilools
confuting chiefly of the drink as it was ta-

2 km

CHAP. m. ON FEVERS, 36^

Jcen in. There feems here to be a fufpenilon
of the power of abforption as well as fecre-
tion in the bowels, in confequence of a ge-
neral fpafm on the extreme veffels ; for;
there is hardly even bile or mucus in the
{tools. There is alfo a particular appear-
ance of the mouth connected with this type
of fever, which is better learned by the eye
than by defcription ; but it confifts chiefly
in a want of moiflure on the lips, and a dry-
nefs and mining appearance of the teeth.
With thefe lymptoms, it will be found
that the patient will bear the lancet in
very advanced ftages of the difeafe. Thefe
fevers feldom occur but in a fporadic way,
unlefs when there is fome peculiarity of
feafon, as at New York in autumn, 1782,
They are alfo more frequent among the
better than the lower fort of people.

By comparing thefe lymptoms with thofe
of the infectious fever above defcribed, there
will appear an obvious difference both in the
nature and treatment.

Treatment

3&J OBSERVATIONS PART III,

Treatment of the Ship Fever,

IN the beginning of all fevers, there
are certain methods which nature takes to
remove the complaint, and in many cafes
thefe afford the belt fuggeftions of practice.
The naufea common in the beginning of fe-
vers, points out the utility of vomiting,
which produces relief both by the evacua-
tion of offending matter, if there mould be
any prefent, and fome how or other by the
effort which takes place in the act itfelf ;
for I have repeatedly feen relief from retch-
ing, when nothing at all was evacuated.
Such is the great and univerfal fympathy of
the ftomach, that the operation of vomiting
affects every fibre and veffel in the body;
and it has been ufed with fuccefs to refolve
tumours in the moftdiitant parts. An early
emetic is therefore the firfh flep to be taken
in the cure of this fever.

If the emetic is given in fmall divided
dofes, it will moll: probably evacuate the

bowels

CJ2AF. ?* Olf FEVERS, 363

bowels downward ; but if it fhould not
have this effect , fome briik purgative medi-
cine mould be given foon after the operation
of the vomit.

I mention thefe evacuations before blood
letting ; for though it ought to be firft in
thofe cafes in which it is proper, it is here
feldom necefTary, and w@ may pronounce it
to be a remedy very ill adapted to this fort
of fever, particularly in a hot climate. It
fometimes happens, however, that there
is violent head-ach, pain of the back and
limbs, with a throbbing pulfe; and thefe
fymptoms may in the very beginning not
only juftify, but require the lofing fome
blood before the emetic or purgative.

The next means of relief I mail mention,
and alfo the moil probable means of cutting
fhort the difeafe, is to excite univerfal fweat.
This being an imitation of nature, is found-
ed on reafon as well as experience, for it is
by fweating that the fit of an intermittent
is relieved and terminated ; and continued

fevers

364 OBSERVATIONS PART III,

fevers in general, if not always*, begin
with a fit of the fame kind. A dry fkin,
accompanied with heat, is one of the
molt, conftant as well as troublefome and
•uneaiy fymptoms in all fevers ; and it
would appear from the peculiar heat of the
fkin in this fort of fever, that there is either
a more than common acrimony of the mat-
ter of perforation, or fomething peculiar in
the mode of circulation on the furface of the
body. Sweating does not feem to operate
entirely by the evacuation of acrimony, for
no relief is procured by it if it is partial ; and
it is evident from a number of facts, that the
ilate of the brain and vifcera depends on
that of the external furface of the body ;
for a free ftate of the pores of the fkin,
provided it is general, tends more than
any other circumftance to relieve internal
pain, and alfo to take off delirium. The
good efFecl of fweating feems, therefore,
chiefly to depend on a general relaxed ftate
of the fmall veffels on the furface of the

* See Dr. Cullen's Firft Lines of the Practice of
Pliyfic*

body ;

CHAP. I. O N F K V E E. S. 3%

body ; and it ought to be effected, if poffi-
ble, by gentle, Toothing means, and not by
fuch regimen and medicines as heat the
body and accelerate the circulation. This
intention is befl anfwered in the beginning
by moderate dofes of antimonial medicines*
and either James's powder or tartar emetic
may be employed. The firft is a more cer-
tain fudorific, being lefs apt than the other
to run off by the bowels ; and its effect will
be ftill more certain, if accompanied with a
mild opiate, rendered diaphoretic hy-fpiritus
Minder eri, which will both prevent the
antimonial from acting roughly, and will
determine its operation to the fkin. A
fweat kept up by thefe means, toge-
ther with plentiful warm dilution, from
twelve to twenty-four hours, is the moft
probable means of bringing about a com-
plete remiffion of the fever; and, in this
cafe, a frefh acceffion is to be prevented by
the immediate adminiitration of the bark.

Thefe are the means proper for flopping
the fever in the beginning, or tending to
render its future progrefs more fafe ; and

though.

OBSERVATIONS PART III."

though, with this view, free evacuations
have been recommended, yet, if the fever
fhould go on, great caution is neceflary 'in
this refpect in the future treatment, debility
being the fymptom chiefly to be guarded
againft. Purgatives may, indeed, be occa^
fionally neceflary, in confequence of accu-
mulations of bile taking place ; but, in ge-
neral, the evacuations by ftool mould not
be more frequent than in health t and fome
of the cafes which were mofl unmanagable
and fatal, were thofe in which there was &
fpontaneous diarrhoea. With regard to blood
letting, it is always hurtful after the firft two
days, unlefs fome inflammatory affedtion of
a vital part mould arife.

The natural evacuation, which may with
moil: fafety and advantage be folicited and
encouraged in this difeafe, is, that by per-
fpiration ; and it is obfervable, that in
thofe cafes for which nature does mo#,
there is a univerfal warm fweat, which has
generally a very ofFenfive fmell, and feems
to be a falutary effort of the conftitution ta
cure the difeafe. Where this takes place;

little

CHAP. I. ON FEVERS, $6?

little medical affiftance is* necefTary, except
to keep it up chiefly by warm dilution ;
and there is no circumftance in which the
judgement of a phyfician is fhewn more
than in diftinguifhing thofe cafes in which
his chief bufinefs is to look on, where na-
ture being equal to the talk, ought not to
be drftuTbed by the active and officious in*
terpofition of art. We mould not, how-
ever, aim at producing a profufe fweat, ex-
cept with a view to effect a remiffion immedi-
ately after the firft evacuations. In the courfe
of the difeafe, it is only necefTary to keep up
a gentle moifture or foftnefs of the fkin.

The head being particularly arretted in
this fort of fever, the patient is extremely
reftlefs and delirious, efpecially at night ;
and there is a medicine which has a mofl
plealing effect in procuring both reft and
perfpiration. This is a combination of an
opiate with an antimonial medicine, which
was adminiftered in the evening with great
fuccefs ; and the fudorific effect is rendered
more certain by the addition of fome faline

neutral,

&6& 0|!BRVATI6US PART lit.

neutral, efpeciall/ ' fpiritus Mindereri*. \
tried pure opiates in the early flage of this
fever, but found them not to anfwer ; though
in the low fevers of England, and in the
advanced ftages and convalefcent ftate of this
fever, they are extremely fafe and ufefuL
Pure laudanum is alfo given by Dr. Lind,
at Haflar, with great fuccefs in the height
of the difeafe ; but in the Weft Indies there
is a greater tendency to acrid excretions, and
the effect of pure opium in caumig a reten-
tion of thefe, feems to be the caufe of its
difagreeing in that climate in the firft ftage
of this fever*

It may here be obferved, that the addi-
tion of a little neutral fait alone will fome-

* The form of adminiftering this medicine was to add
twenty drops of thebaic tincture, from half a grain to a
grain of emetic tartar, and from five to ten grains of
nitre, to two ounces of water or camphorated julep, of
"Which one half was given about two hours before the
common hour of reft, and the remainder at that hour*
If fpiritus Mindereri is preferred to the nitre, it may bef
given from two drrchms to half an ounce for a dofe, and
it is better to adminifter it feparately ; for if it fhould not.
be exadtly neutralized, it may decompofe the antimoniaJr
and render it inactive.

times

CHAP. I. ON FEVERS. 369

times fo qualify the operation of opium, as
to prevent its bad effects, fuch as the in-
creafe of febrile heat and delirium, and the
ilupor and head-aeh which, when given
alone, it frequently induces the following
day. I have generally employed nitre with
this intention*

But with a view to perfpiration, the fpiri-
ius Mindereri is the mofl effectual neutral
medicine when conjoined with an opiate,
and there is not, perhaps, a more fafe and
pleating diaphoretic known than a combina-
tion of it with fyrup of poppies*. There
is fome neutral fait in Dover's powder,
and this has more effect than could be ex-
pected from fo fmali a quantity of an inert
medicine ; for I know from trials of my
own, as well as thofe of others, that ipe-
cacuanha and opium given together, in the
proportions prefcribed in that powder, will

* I firft learned this, as well as many other ufeful and
practical facts., fiom Mr. Farquhar, Surgeon in London,
who has laid me under the greateft obligations by com-
municating many of his obfervations, derived from the
moftextenfive experience and a truly ^e*\etrating fagacity.
JB b not

370 OBSERVATIONS PART III.

not have the fame effect as when joined with
the neutral fait. This is an inftance of
thofe ufeful combinations of medicines which
can be difcovered only by experience, but
which every phyfician ought gladly to adopt
in practice upon good teftimony and fair
trial, though he may not be able to account
for their effects, nor to explain their mode
of operation.

There is nothing more important than
plentiful warm dilution ; and the infufion of
fage, or any fuch light aromatic, is rather
more proper than farinaceous decoctions, or
any compolitions in which there is wine or
fpirits. Succefs in this as well as other
difeafes, depends on attention to nurfing as
much as •upon medicine ; for what would it
avail here to adminifter medicines for pro-
moting perfpiration, unlefs they were affift-
ed with fluids to allay thirfr, to dilute the
acrimony in the flrrt paffages and in the
veffels, and to furnifh the materials of free
perfpiration ?

But

CHAP. I. ON FEVER s; 371

But however defirable it may be to pro-
cure fweat, this is not to be attempted by
clofe rooms and bed clothes, nor by hot
medicines, fuch as volatile falts, ferpentary,
fpirituous tinctures, or aromatics. Thefe,
according to the teftimony of Sydenham,
tend to increafe the heat and delirium, and
to produce petechia, miliary eruptions, or
local inflammations. In the intervals of
the anodyne diaphoretic above defcribed, fpi-
ritus Minder eri and fmall dofes of camphor,
with proper dilution, may be fafely employ-
ed to procure a foft fkin.

The only other means I mall mention
with this view is, the application of warm
moiflure to the furface of the body, which
may be done by foaking the feet and hands
in warm water, or by fomenting the feet
and legs with ftupes*. Thefe operations
have the effect of bringing on a general re-
laxation on the fkin, thereby taking off fe-
brile agitation and delirium, and inducing
fleep. I fometimes, with feeming benefit,

* I owe this piece of inftruction, as well as many
others, to Dr. Cullen's Lectures.

B b 2 ordered

372 OBSERVATIONS PART III.

ordered cataplaims to be applied to the feet,
merely of the emollient kind, without muf-
tard or any other acrid fubffance, being in-
tended to relax, and not to Simulate.

In the nfe of pediluvia and fomentations,
there is a drfference worth attending to be-
tween the practice in this fever, and that in
the inflammatory fever before defcribed, for
they are as hurtful in the latter as they are
beneficial in the former. I have obferved, in
general, that they have a bad effect in all
cafes where there is fizy blood* particularly
where the breaft is affected.

Delirium is one of the mofr, conftant and
alarming fymptoms in this difeafe, and the
removing of it depends much upon the at-
tendants as well as the phyfician. It has
been faid before, that it depended on a falfe
apprehenfion of the impreffions, or natural
fenfations. When a perfon, for example,
labours under delirium, and is affected with
thirft, the mind is either fo agitated with
Other objects, that this fenfation is over-
looked, or, inflead of producing a craving

for

CftAP. I. O tt FEVI'Ri. 373

for drink, it excites fome other difagreeable
emotion in confequence of the difordered
itare of the fenforium. This lafl fcems to be,'
probable from the ceflation of delirium,
which will take place upon a natural want
being fatisfied. I have feen a temporary
flop put to the patient's raving by making
him drink, or upon his difcharging his
urine or feces ; for he is then unconfcious
of thirfl: and other natural wants, is there-
fore ignorant of the means of fatisfying
them, and when he does fo, he fancies he
is about fomething elfe which is the fubject
of his delirious thoughts. This obfervation
leads to a material practical purpofe ; for it
follows from it, that unremitting attention
mould be given to the patient's feelings and
all his poffible wants, as thofe natural no-
tices and inftinclive cravings which occur in
health, are now wanting, in confequence of
the depraved ftate of fenfation.

Moft of the remarks that have hitherto
been made, apply to the earlier ftages of
the difeafe. The principal remedies appli-
cable in the more advanced flages are, blif*
ters, Peruvian bark, opium and wine.

B b 3 . I have

374 OBSERVATIONS PART III,

I have found what Dr. Lind fays con-
cerning the efficacy of blifters, confirmed
by my own experience, efpecially in thofe
fevers in which there was great delirium or
coma ; but I have not experience enough to
fay whether they were as ufeful in the begin-
ning of the difeafe in the Weft Indies as he
found them to be in England.

The men that were brought from the
mips to the hofpitals were afFe&ed with the
difeafe in various ftages ; but as we had in
general a very inaccurate hiftory of the'feve-
ral cafes, the method of treatment, upon
their firft admiffion, was pretty nearly the
fame in all ; and it coniifted, in the firft place,
in warning their face, hands, feet and legs,
with warm water and vinegar, from which
they derived the greateft comfort, being com*
monly very dirty. We had generally very
Indiftincl information about the ftate of their
bowels as well as other circumftances, on ac-
count of their delirium ; but it was at any
rate ufeful, or at leaft fafe, to give them a
clyfter. They were enjoined plentiful dilu-
tion ; and if they were low, fome wine and

water

#HAP. X. ON FEVERS. 375

water was allowed. In the evening, the ano-
dyne diaphoretic medicine was adminiftered,
and a bliiter applied to fome part of the body.
In confequence of this method, we feldom
failed to find the patients better next morn-
ing; and it was tried in fuch numbers, that
the efficacy of it was fufflciently afcertained.
It happened in fome cafes, that thefe means
were omitted, and a comparifon of thefe
with the others ferved to afcertain the true
'efficacy of the medicines ; the flationary
itate of the iymptoms, when the difeafe
was thus left to itfelf, fufflciently proving
the propriety of the treatment above de-
scribed.

It is an important queftion to what cir-
cumftances of this fever the Peruvian bark
is adapted. An early and indilcriminate
life of it is recommended in fome late publi-
cations, upon the authority of which I tried
it without regard to the flages or fy mptoms,
and without any prejudice either for or
againfr. the practice ; but I found that this
powerful remedy was in danger of doing
much harm, unlefs great attention was paid
B b 4 to

37& OBSERVATIONS PART III*

to circumftances in order to diftinguifh the
proper feafons for giving it. The fymp^
toms that forbid the ufe of bark are chiefly
foul bowels, hard pulfe, fizy blood, great
delirium, dry tongue, a hot and dry ikin,
and inflammatory affections of the vifcera.
It was found extremely pernicious in an
early ftage of the difeafe previous to evacua-
tions; and the object of practice at this time
fhouid be to relieve the habit by means of
thele, in order to produce a general relaxa*
tion of the fecretions, and to render the ikin
cool and foft, thereby paving the way for
the bark.

It is not neceuary, however, efpecially in
the advanced flages of the difeafe, to wait
for an abfolute remiffion in order to admir
nifler the bark. It is fometimes adminicle
when there are fymptoms of general debi-
lity, fuch as a fmall pulfe and mufcular
weaknefs, though the frequency of the pulfe,
delirium, and even a dry Ikin and tongue,
fhouid indicate a confiderable degree of fever.
It may be remarked by the bye, that a dry
tongue is a fallacious fymptom, for it may

happen

happen in eonfequence of the patient's
breathing through the mouth inftead of the
nofe, without any fault in the fecretions of
the fauces. The fymptom which forbids
the ufe of the bark more abfolutely than
any other, is an inflammatory or dyfenteric
ftate of the bowels, in which cafes it feems
to be invariably pernicious.

Where it happens that we are extremely
anxious to throw in the bark, as we ufually
are in the Weft Indies, where fevers are
very rapid and dangerous, and yet the
fymptoms feem hardly to admit its ufe, it
was very commonly tried either in conjunc-
tion with fome antimonial medicine or neu-
tral fait, or thefe were given alternately
with it, in order to foften and qualify its
effects by preventing it from heating or
otherwife aggravating the fymptoms. An-
timonial wine ovfpirjtus Mindereri were con-
veniently employed with this intention.

With regard to the quantity of bark to be

given, it may be proper in doubtful cafes pf

this kind to begin with fmall dofes, in order

J 2 to

37§ OBSERVATIONS PART III,

to feel how far it agrees or not ; but in ge-
neral it may be laid down as a rule with re-
gard to this medicine, that, where it is
really proper, and the medicine to be de-
pended on, it is to be given in as large dofes
and as frequently as the ftomach will eafily
bear it.

The next remedy mentioned was opium.
It is a medicine more admiffible and ufeful
in this than any other kind of fever. The
fame cautions nearly apply in the admins
juration of it as have been given with regard
to the Peruvian bark. The caution with
regard to foul bowels is particularly necef-
fary in a hot climate, where an over fecre-
tion of bile is fo apt to take place. When
the Boreas frigate arrived from England in
March 1733, there was a very bad fever of
the infectious kind on board, fome cafes of
which being fent to the hofpital at St, Lu-
cia, were treated unfuccefsfully with bark
and opium, which I had been induced to
try upon the authority of the authors above
alluded to. I attributed this want of fuc-
cefs to the neglect of previous evacuation ;

for,

«HAP. U ON FEVER Si 379

for, upon infpecting the bodies, the inteftines
were found full of bilious feces* I profited
from this, and was more fuccefsful in the
other cafes. It were to be wifhed that phy-
ficians could oftener bring themfelves to con-
fefs their errors in practice, and their wri-
tings would be more inftruclive ; for it is of
confequence to know what we are to avoid
as well as what we are to follow.

It has been mentioned, that the beft ef-
fects arife from the conjunction of an anti-
monial with an opiate ; but, in this fort of
fever, antimonials are hurtful after the firft
ftage, and opiates may be given alone or
combined with camphor. With regard to
the precife period of leaving off antimonials,
it muft be left to difcretion, and the flrength
of the patient is the beft guide. If he is not
very much funk, and if there are bilious
iy mptoms or an obftinate drynefs in the
fkin, a few grains of James's powder may
be given with advantage in an advanced pe-
riod of the difeafe. If a hot and dry fkin
mould at this period be the only trouble-
fome fymptom, it will be more fafely and

effectually

3S0 OBSERVATIONS PART III,

effectually removed by camphor combined
with fomething opiate and neutral, than by
antimonials, which, at this time, would be
m danger either of ruffling the patient, or of
weakening him more than he could bear.

But, in a flill more advanced and low
Hate of the fever, even neutral falts are to
be laid afide, as they tend too much to
lower the patient. Evacuations being then
alfo improper, clyflers only are to be em-
ployed in cafe laxatives mould be neceffary.

In this advanced ftage of the fever, in
which the moft common fymptoms are weak-
nefs, reftleffhefs, tremors, and low delirium,
no medicine was found {p much to be trufled
to as opium, which here acts as a cordial as
well as an anodyne and antifpafmodic. It
may be given in the form of tincture,
from five to ten drops every fix or eight
hours, or fome of the officinal compounds,
fuch as the theriaca or mithridate, may be
employed with advantage. I have thought
alfo, that at this period caflor, conjoined
with opium, feemed to improve its virtue.

This

CHAP. I. ON FEVERS. 381

This was rlrfr, fuggefted to me by Mr. Cru-
die, an ingenious German furgeon, whom I
employed as an affiftant at the hofpital at
St. Lucia ; and fince I have been phyficiati
to St. Thomas's hofpital, I have found the
moft pleafing effects, in limilar cafes, from
a compofition ufed there, the principal in-
gredients of which are opium and caftor *..

In this jftate of the fever I have alfo ufed
with advantage the decoclion of Peruvian
bark and ferpentary, as recommended by
Sir John Pringle ; and when the circula-
tion is very languid, as is ibmetimes the
cafe, volatile falts may very properly be
employed.

But in the advanced ftate, and in the
word forms of this difeafe, there is perhaps
no medicine fuperior to wine. This was

* The following is the form of it, and it was firft in-
troduced by Mr. Whitfield, apothecary to that hofpital,
under the name of Bolus Sedativus. $. Confection.
Damocrat. zfs, Caftor. Ruffic. pulv. 9fs. Tindr. The-
baic, g"- iv. Syr. fim. q. f. Fiat bolus fexta quaque bora
iumendus.

given

38t OBSERVATIONS tA*T III.

given either pure, of diluted with water for
common drink, and fometimes to the quan-
tity of a quart in twenty-four hours. In de-
licate people, fuch as we meet with in pri-
vate practice, the quantity ought to be lefs.

There is this caution neceflary with re-
gard to the ufe of wine, that when the fe-
ver is gone off, and only extreme debility
remains, the free ufe of it is not fafe nor
proper ; for, in a weak and exhaufted ftate,
a perfon is more apt to be * heated and in*
toxicated by any fermented liquor, than in
health, or even in the preternatural and dif-

* Great nicety Is required in all cafes with regard to
the times and dofes of cordials ; for it by no means fol-
lows that thefe mould be in proportion to the lownefs and
lofs of ftrength. This is well iiluftrated by Mr. Hun-
ter in his Lectures, where he explains the diftinclion be-
tween the powers of ths body and its acfions. There
rauft be a certain degree of ftrength to bear the excite-
ment occafioned by ftimulating and ftrengthening medi-
cines or diet ; for nothing is more pernicious, or even
fatal, than that any part or function ihould make exer-
tions beyond its ftrength ; and there- is the more danger
in ill-timed remedies of this kind, as a ftate of weak-
nefs is generally a ftate of irritability.

turbed

CHAP. I. ON FEVERS* 3S3

turbed Hate of aclual difeafe, fuch as occurs
in this fever.

After the difeafe is removed, a long {late of
weaknefs is apt to fucceed,efpeciallyin a warm
climate. The moft proper remedies, then, are
bitters, fuch as decoctions of Peruvian bark,
infufions of quaffia bark, or camomile flowers.
Thefe anfwer better than the bark in fub-
ffcance, which is now apt to naufeate and
load the flomach, and the patient is apt to
take an averfion to this and whatever elfe
he took in a flate of ficknefs. The bell
ftrengthening medicines are fuch as comfort
the ft.omach and create appetite ; and we
may mention Huxham's tincture of bark, in
fmall dofes, and a moderate ufe of wine, as
the molt, proper for thefe purpofes. Where--
colliquative Iweats take place, elixir of vi-
triol is ferviceable, and with this intention I
have joined it, with evident advantage, to the
evening anodyne, which, without fuch a cor-
rector, tends rather to aggravate this fymp-
tom. I have known aflafcetida prove a ufe-
ful flimulus to the ftomach at this time, and
it may even be ufed while the fever fubfifls,

efpecially

3$4 OBSERVATIONS PART lit*

efpecially where the fecretions of the fauces
are fcanty. This medicine is recommended
by Sir John Pringle in the fame circum-
ftances. But I confider the prudent life of
opiates, particularly at bed time, as the moft
effe&ual cordial and ftrengthening medicine
in this convakfcent ftate.

But with regard to the management of
the lick at this time, as much depends on
diet as medicine. Nothing has been faid
concerning this in the acute ftate of fever,
becaufe no nourishment is then necefTary.
In that ftate there is a loathing of all food,
and the powers of digeftion and affimilation
feem to be then fufpended, fo that alimen-
tary fubftances become not only an ufelefs
load, but orTenfive and hurtful by turning
acid or putrid. It is likewife evident from
fact as well as reafon, that nature, in this
iituation, does not require fuflenance ; for
we frequently fee people labouring under
fevers who do well and recover, though
they have been entirely without nourifhment
for a length of time in which the like ab-
stinence in a ftate of health would have

proved

proved fatal. The friends and attendants
of the fick, from a prejudice not unnatural,
but not conlidering the difference between
health and that ftate of derangement which
takes place in fever, are for ever wifhing to
fupply the patient with nourishment, and
every phyfician meets with trouble in coun-
teracting this officioufnefsd Neverthelefs,
when the fever draws out to a considerable
length, and the principal fymptom is that
Hate of weaknefs which, in low fevers, runs
infenfibly into that of convalefcence, then it is
neceffary to pay the utmoft attention to nou*
riShment, and nothing tends more to infure
and haften recovery than the affiduous admi-
nistration of light and nourishing food, the
fame cautions being obferved which have
juft been mentioned with regard to cordials;
One of the greateft hardships of a fea life is
the want of thofe articles of diet that are
fuitable to a recovering State, and many
lives are loft from this circumftance, after
the force of the difeafe has been fubdued *•

* See a method propofed for obviating this, page 335.

C c With

386 OBSERVATIONS PART III.

With regard to the peculiar form, before
defcribed *, which this fever aflumes a few
months after mips have been in the climate,
we found camphor, volatile falts, and fer-
pentary, the bell: remedies. As there was a
remarkable coldnefs of the flcin, I was in-
duced in one cafe to try the hot bath, and
with good effecT:, from which it feems proba-
ble, that a fhort flay in a bath, of a heat
from 960 to ioo°, fo as to have its warming
and ftimulating, without its relaxing effects,
would anfwer well in fevers of this kind.

2. Of the Bilious Remitting Fever.

THIS is peculiar to tropical climates, and
arifes in the fame fituations in which inter-
mitting fevers arife in temperate and cold
climates. It feldom arifes at fea, unlefs
where there has been previous expofure on
fhore, of which fome examples occurred in
the firft, part of the work. It may gene-
rally be traced to the air of woods or

* Page 357 and fe^.

marines ;

CHAP. I. ON FEVERS. 387

marines ; and in our fleet hardly any men
were attacked with it but thofe who were
employed in the duties of wooding and
watering.

The moft diftinguifhing fymptom is a co-
pious fecretion of bile which attends it. Its
courfe, in general, is fhorter than that of
the feveF before defcribed, and though the
fymptoms are more violent, they are not fo
equal and fteady, owing to the tendency
there is to remifiion. The fymptoms are
particularly violent at the beginning, in fo
much, that fome of the men, after being
expofed upon duty to the heat of the fun
and the air of marfhes and woods, would be-
come frantic, being feized almoft inftanta-
neoufly with delirium refembling madnefs.
This fever, when it arifes merely from the
effluvia of woods and marfhes, has a natural
tendency to remit ; nay, fome fevers at St.
Lucia, proceeding from this caufe, were
of the pure intermitting form from the be*
ginning. But in many of thofe that arofe
at Jamaica, little or no remiffion was to be
perceived ; and it was diftinguifhed from the,
C c 2 fhip

OB 8 £ R V A T I O X S PA^tT -l$fo

fhip fever by the bilious vomits and ftools,
more violent delirium, and head-acb, and
by being attended with lefs debility. The
greater tendency to the continued fojrm at
this time, was probably owing to this cir-
eumftance, that the men who were expofed
to the land air in wooding and watering,
were then expofed alfo to fuch caufes as
naturally produce continued fevers, fuch as
infection,- the foul air of the French prizes,
intemperance and hard labour. There was in
fome cafes a yellownefjs of the eye, and even,
of the whole &in, but without the other
fymptoms that chara&erife the yellow fever,
properly fo called.

In cafes that proved fatal, the fymptoms,
for fome time before death, refembled very
much thofe of the fever before defcribed a£
the fame ftage. There was either coma or
eonfrant delirium, great feeming anguim>
the mouth and tongue very dry, or with
©nly a little ropy (lime, a black cruft on the
teeth, picking of the clothes, and involun-
tary ftools.

Treatment

«KAfT..Ii ON: F E,V E R S.- 389?

Treatment of the Bilious Remitting
Fever.

THE meafures proper to be taken in- the
beginning of fevers are pretty nearly the
fame in all. There is little difference in the
-firft. treatment of this from that of the fhip
fever, except that blood-letting is here more
frequently proper, and that a more free eva*
cuation of the bowels is neceifary on accounjt
of the more copious fecretion of bile.

In full and athletic habits the difeafe very
commonly begins with pains in the limbs,
back, and head, with a fbong throbbing
pulfe ; in which cafe it is proper firft of all
to let blood at the arm. This is ,alfo highly
proper and neceflary in thofe cafes mentioned
above, in which the patient becomes fud-
denly frantic. But though the cafes requi-
ring blood-letting are more frequent in this
fort of fever than that already treated of, yet
great caution and nice difcernment are ne-
ceflary with regard to it, in all cafes, in a
C c 3 hot

3^0 OB4BHVATIONS PA*T III,

hot climate. As fevers in fuch a climate
run their courfe fafter, the fymptoms fuc-
ceeding each other in a more clofe and hur-
ried manner, greater expedition as well as
difcernment are required in timing the diffe-
rent remedies than what are neceifary in a
cold climate. Blood - letting unfeafonably
and injudicioufly employed either endangers
life, or has a very remarkable effect in pro-
tracting recovery, by the infurmountable
weaknefs it induces.

With regard to the evacuation by the
bowels, it has already been mentioned in
another part of the work, when on the
fubject of prevention, that, before the fever
comes on, there is a languor and general
feeling of indifpofition, and that then an
emetic and a purgative, followed by fome
dofes of the bark, were the mofl likely
means of preventing the attack of the dif-
eafe. If the fever has properly begun, which
is announced by a rigor taking place, then
no time is to be loft in procuring evacuation ;
and, after blood letting, if the fymptoms
ihould require it, the beft medicine is tartar
3 emetic,

emetic, which, if given in fmall divided
dofes, at fhort intervals, will moil probably
evacuate the whole inXeftines by vomiting
and purging, and may even prove fudorific.
But it will neverthelefs be proper to admini-
fler a purgative medicine foon after ; and what
we found to operate with moft. eafe, expedi-
tion, and efFedt, was, a folution of purging
falts and manna, either in an infufion of
fena, or in common water, or barley water,
with fome tincture of fena added to it.

The next flep towards procuring a re-
miffion is, to open the pores of the (kin,,
which is beft done by fmall dofes of James's
powder or emetic tartar, aflifted by fpirhus
Mmderlri and plentiful warm dilution. I
once, by way of comparifon, tried thefe two
antimonial preparations in a number of men
ill of this fever, who were fent to the hofpi-
tal together, giving emetic tartar to one half,
and James's 'powder to the other ; and their
eftecls were io fimilar, that I could perceiv®
no reafon for preferring the one to the
other. Antimonial medicines feetn better
C c 4 adapted

%q% OBSERVATION* PART III*

adapted to this than any other fort of fever,
and may be more freely given in it.

Thefe are the moft likely means of bring-
ing about a remiffion ; and if this is effee*-
ted, nothing remains to be done but to
throw in as much Peruvian bark as the {to*,
mach will bear.

But whether from a frefh accumulation
of bile, or fome other circumftance, it may
happen that the fever is kept up, and in
this cafe there is commonly a fenfe of weight
or uneajinefs about the hypothondria, which,
feems to indicate that the redundant bile is,
jn the gall bladder or duds, of the liver. la
this cafe a repetition of evacuants is nece£>
fary, and calomel will be found to anfwer
remarkably well as a purgative, its ftimulus.
being fo extenfive as to loofen and bring
away bile when the faline purgatives, fuch,
as that above mentioned, had failed of hal-
ving that effect, I have known thefe to.
pafs through the inteflines^ without relieving
the uneafy fenfation about the ftomach
as calomel is found to do ; and it will

be ftill more effectual for this purpofe, if
given alone in a dofe, from five to ten grains,
and followed fome hours afterwards by forne
other purgative. After this, antimonial me-
dicines are again to be had recourfe to, and*
thefe, as well as purgatives, are fafe and
ufeful in a more advanced ftage of this
fever than they are in the fhip fever, for
the ftrength is not fo apt to link, and the'
irate of the bowels requires them more.
Antimonials, however, are to be ufed fpa-
ringly and cautioully as the fever advances^
for I have known them, when given only a
few days after the firfr, attack, to have the
effect in fome conititutions, of making the
fjhomach fwell, and of producing a general,
Jjenfe of heat and uneafinefs.

After the evacuations of the bowels, the,
anodyne diaphoretic may be ~ery ieafonably
given in the manner formerly mentioned ;
for it will not only tend to footh and pro-
cure fleep after the commotion that has b :en
excited, but by its gentle fudorific effect will
gffift in completing the remiffion.

The

39$ OBSERVATION'S PART III.

The principal point of management in
the fevers of this climate is, to throw in
the Peruvian bark in proper feafon. I for-
merly took occafion to differ from the opi-
nion of thofe who allege that little or no
difcrimination is neceflary with regard to
the circumftances in which bark is proper
in continued fevers. 1 made fair and unpre-
judiced trials of this, but always found that
ibme fort of remiflion, efpecially towards
the beginning of the difeafe, was necefiary,
in order to make the ufe of this medicine
fafe and proper. The greateft vigilance is
indeed required that the adminiftration of it
be not omitted when it is at all advifable,
as the courfe of fevers is very quick and
critical in this climate. I have watched
many nights with fome friends in whofe
health I was particularly interefled, to catch
the hour when it might be allowable to give
it ; and where the propriety of it was fome-
what ambiguous, it was ufual to qualify it
either by conjoining fome antimonial or neu-
tral fait with the firfl dofes, or by giving
them alternately with it, as has been for-
merly mentioned.

Under

CHAP. X. OK FEVHJ, 395

Under the ufe of thefe means, the favour-
able fymptoms are, a warm moifl lkrn, a
flrong fteady pulfe, with the pulfations
under a hundred in a minute, a natural coun-
tenance, and being free from delirium.
But if the fever fhould not yield during the
firft week, but takes an unfavourable turn,
the ptilfe then becomes more fmall and
frequent, there is a general agitation, the
tongue is tremulous when put out, there
is great thirft, a dry hot fkin, and delirium.
In thefe circumftances, befides the continu-
ation of the antimonials in fmaller dofes,
with the anodyne diaphoretic and the occa-
fional ufe of purgatives, bliflers now become
proper ; and we found alfo camphor com-
bined with nitre an excellent medicine at
this period of the difeafe.

Should the patient furvive to the end of
the fecond week, the treatment then comes
to refemble more and more that of the in-
fectious fever already defcribed. Bark may
be given, though there fhould be no proper
remiffion, and cordials and opiates may be
more freely ufed. Attention to the flate of

the

396 OBSBEWATtlCTSS t *RT Jftfe

the bowels will iHll be neceflary, fince repeat-
ed accumulations of bile are apt to occur
even in the mofl advanced ftage, and gentle
emetics of ipecacuana, as well as laxatives,
may be neceflary. For the fame reafon alfo,
greater caution is requiflte in the ufe of
pure opiates than in the infectious fhip fever
before treated of. In order to keep the
bowels foluble, it was a very ufual. practice,
and found very ufeful, to conjoin, a few
grains of rhubarb with each dofe of the bark*.

3. Of the Ye 1, low Feverv

THE fever lafr. treated of may be faid to
be peculiar to a hot climate ; but the hot
feafons of temperate climates produce fome-
thing refembling it. That now to be de-
fcribed never occurs, fo far as I know, ex-
cept under the influence of tropical heats*
Such a fever is indeed known without the
tropics ; for -it is very common in Carolina^
in the hot feafon ; but there the heat is
even greater than that of the Weft Indies,
In order to produce it, there mufr. be, for
1 fome

6BA*. f-\ O N E E V E R S. 597

feme length of time, a heat feldom falling
below feventy-iive degrees on Fahrenheit's
thermometer.

Though: it differs from the fever laft $e-
fcribed both in its caufes and iymptoms, it
is. not meant to fay that it is fo diftin£l as to
form a feparate fpecies of difeafe, like the
meafles and fmall-pox. Uoiefs the ^charac-
ters of fevers are flrongly marked, it is dif-
ficult, and even impoffible, to refer them to
any particular fpecies ; and the different con-
currence of caufes and constitutions is fo va-
rious, that great numbers of ambiguoui
cafes occur. -

With regard to the caufe of the yellow
fever, it differs from the bilious remittent in
this — that the air of woods and marines
is not neceflary to produce it ; for it mofl
commonly arofe from intemperance or too
much exercife in the heat of the fun. It
was obfervable, however, that it was more
apt to arife when, befides thefe caufes, men
were expofed to unwholefome land air, or
to the foul air of fhips, wh«ther- from in-
fectious

398 OBSERVATIONS *ART III,

fe&ious effluvia, or proceeding merely from
the putrefaction that takes place in neglected
holds.

It is alfo remarkable with regard to it, that
it is confined almofi entirely to new comers
from a cold or temperate climate. It is called
fevrede Matelot * in fome of the French iflands,
which mews how much it is confined to
thofe who have newly arrived there. This is
fo much the cafe, that I have known medical
gentlemen, natives of the Weil Indies, who
had hardly ever feen it, their practice lying
at a diftance from any fea-port town, where
Grangers ufually arrive. Of thefe Grangers,
thofe who are young, fat and plethoric, are
molt apt to be attacked, and more of our
officers, in proportion, were feized with it
than the common men.

It has been faid, that it never attacks ei*
ther the female fex or blacks. This is in
general, though not abfolutely true ; for I
knew a black woman, who acted as nurfe to

* The Sailor's Fever,

fomc

«HAf. I. ON FETER5. 399

fbme men ill of this fever at Barbadoes,
who died with every fymptom of it.

This fever aflumes various forms, accord-
ing to the peculiar constitutions of different
men, and other circumflances ; but in the
following defcription I mall enumerate the
mofl common appearances : — In general it
begins with alternate flulhes of heat and
cold, feldom with thofe rigors which coniti-
tute the regular cold fit, and with which
moil other fevers begin* Thefe are imme-
diately fucceeded by violent head-ach, pain
in the back, univerfal debility, ficknefs,
and anguifh at the ftomach. There is com-
monly, in the beginning, a good deal of
bile on the ftomach, which is thrown off
by vomiting, either natural or excited by an
emetic. Thofe men who were taken ill of
this fever in the Alcide, in the end of the
year 1781, had a fore throat in the be-
ginning ; but this is not a common fymp-
tom.

In the courfe of this difeafe, there is by
HO means a free fecretion of bile, and leafl

405 OBSERVATIONS PART tit

of all ill thofe cafes that are moft violent j
and prove the foonefl fatal. In cafes that
are more protracted and lefs defperate, there
are frequent accumulations of it, as appears
by the vomits and ftools.

The eye in a few hours, takes a yellow
tinge, which foon after extends more or lefs
over the face and whole ikm. This h a
fymptom fo ftriking and conilant, that it
gives name to the difea'fe, though it is not
abfolutely either peculiar or effential to it.
There is fomething contagious in this fymp-
tom which feems fomewhat fingular, and
difficult to be accounted for. It was obfer-
ved in the Royal Oak and Alcide to extend
to men who were but flightly indifpofed;
and at the hofpital it fpread to men in the
adjoining beds, without imparting any ma-
lignity to their dirfeafes#

There is fomething very peculiar in the
countenances of thofe who are feized with
it, difcernible from the beginning by thofe
^vho are accuflomed to fee it. This appear-
ance confifls in a yellow of dingy flushing

CHAP. It O N P £ V £ R t. 4or

or fullnefs of the face and neck, particu-
larly about the parotid glands, where the
yellow colour of the Ikin is commonly firft
perceived. There is alfo in the eye and
mufcles of the countenance a remarkable
expreffion of dejection and diftrefs.

One of the moft conftant and diftinguim*
ing fymptoms of this fever is an obftinate,
unremitting and painful pervigilium, which
is the more tormenting, as the patient is
extremely defirous of fleep. It is feldom
that even a delirium comes to his relief to
make him forget himfelf for a moment ;
but he continues broad awake night and
day, with his reafon and fenfes found, in a
ftate of the moft uneafy agitation.

But the moft diftinguifhing fymptom?
and that which is expreffive of the greatefl
danger, is, an unconquerable irritability in
the ftomach, which can be brought to bear
nothing. An almoft. inceflan t retching takes
place, which commonly, on the third day5
ends in what is called the black vomit, the
moft hopelefs of all the fymptoms attending.
D d it.

4Q2 OB8SRVATION9 PART tW,

it. When this is examined, the colour i&
found to be owing to fmall dark flakes re-
fembling the grounds of coffee, and feem$
to be blood which had oozed from the furface
of the ftomach, a little altered. Indeed pure
blood is fometimes thrown up, and we
know that the red globules enter the fmaller
order of veffels, and ifl'ue by thern, for
bleeding at the nofe is a common fymptom
about this time, and fome relate that it alfo
efcapes by the ears and pores of the lkinr
which I never faw, but can readily believe
it. At the fame time, the ftools grow
black, and the urine is frequently of a very
dark colour, which feem to be owing to
the fame caufe. I never remember to have
feen any one recover after thefe fymptom s
came on.

There feems to be a general error loci of
the more tenacious and globular parts of the
blood into the fmaller order of vefTels, to
which the yellow colour is in a great mea-
fure owing ; and when any part of the fkin
is ever fo little prerTed upon, a damafk red

colour

ciIap. t. ON FEVERS. 4°3

colour remains for fome time, the fmall
veflels readily admitting the red globules.

In the wdrft form of this difeafe there is
all along an uncommonly diftreffing fenfa-
tion of univerfal anguifh, particularly about
the ftomach, where there is a fenfe of
burning heat, which, as the miferable. fuf-
ferers themfelves exprefs it, becomes tin-
fpeakable torture.

A fenfe of weight at the breaft, deep and
frequent fighing, and a great failure of muf-
cular ftrength, are dangerous fymptoms in
all ftages of the difeafe.

Upon the firft attack the fkin is extremely
hot and dry, and the pulfe hard and fre-
quent ; but the external heat foon becomes
Very little different from the ufual flandard
of health, and the fkin feels foft and moilt.
There fometimes happens an eruption of
fmall puflules, with white heads, on the
trunk of the body, which is a favourable
fign, and I have feen a head-ach difappear
upon this breaking out. The pulfe does
Dd 2 not

40| OBSERVATIONS PART tit.

not ferve as an index of danger ; for, after
the hurry of the firfr. attack, it becomes
very moderate in point of frequency, vary-
ing from 80 to 100 pulfations in a minute,
and is natural in point of regularity and
ftrength.

In thefe eircumftances this fever differs
from that which was laft defcribed ; and it
alfo differs from it in being attended with
little delirium. I have feen cafes in which
the fenfes were not affected from beginning
to end ; and I never obferved that violent
and inceffant delirium which attends other
dangerous fevers.

The ftate of the fauces is alfb different
from that of moil other fevers; for there
is no exceffive thirif.. The tongue is fome-
what white and foul ; but I do not remem-
ber ever to have feen it black and dry.

A want of action in the bowels, and an

infenfibility to purgative medicines, indicate

great danger; and next to the black flimy

{fools, one of the rnoft unfavourable fymp-

1 toms

CHAT. W O N F E V E R ft 4OJ

toms is, when the^/flw are like white clay,
as 1 have feen in fome cafes that ran out to
the length of a week before they proved fa-
tal. When the black vomit and ftools OL^ur*
death commonly happens on the third or
fourth day. A bilious diarrhoea fpontaneoufly
coming on, is a very favourable fymptom.

In more unpromifing cafes the urine is
fcanty, and in the lafr, ftage of life it be»
comes of a very dark colour, as was men-
tioned before. A plentiful feeretion of urine
is a very favourable circumftanee, and feems
to be one of nature's methods of curing the
difeafe ; for fuch cafes are obferved to ter-
minate well. I remember one cafe in parti-
cular in which feveral quarts were made
daily for feveral days together, and it was of
a very dark fafFron colour, but looked green
where the furface was in contact with the
fide of the pot. I infpiffated a fmall quan-
tity of it, and found a large refiduum,
which was very deliquefcent, and feemed
to be all faline. In a hot climate the urine
does not (hew that feparation and depofition
which denote the crifis of fevers in cold cli-
D d 3 mates,

4QS observation* fart *n»

mates, and this is perhaps owing to there be-?
ing lefs mucilage and more alkali, on account
of the more putrefcent ftate of the fluids in
the former. Upon adding a little vinegar :
to the urine in the cafe above mentioned, it
became turbid like the critical urine of thje
fevers of Europe.

At the approach of death, cold clammy
fweats come on ; the pulfe continues regu-?
lar and of a certain degree of flrength, but
grows flower and flower. I have counted
it at 40 pulfations in a minute. The pa-
tient is frequently fenfible to the lafl mo-
ment ; nor does the countenance link into
what is called the Hippocratic appearance. In
other cafes I have feen, at this time, coma,
and not unfrequently convulfions. Broad
livid fpots fometimes alfo appear on the
fkin. Extreme mufcular debility, a great
difficulty of deglutition, and a dimnefs of
the eye-fight, are lijtewife common fymp-
?oms in the laft fcene.

The different flages which lead to diflblu-
tion following each piher thus rapidly, there

CHAP. U t> 1* ? E V E R S. 40J

is not that gradual failure of the powers of
nature that ufually give warning of ap-
proaching death ; but the fprings of life
run down, as it were, at once, the wretch-
ed fufferer expires, and is happily delivered
from the moft extreme mifery of which hu-
man nature is capable.

Such is the general train of fymptoms
in this fever, taken entirely from my own
obfervation ; but great varieties occur both
in the fymptoms and duration, fo great in-
deed, that it is hardly recognifable for the
fame difeafe. I (hall give fpecimens of fuch
anomalous cafes in two that occured at Port
Royal, on board of the Canada, in July,
1782.

A lieutenant of that (hip had been fubr
jccl, for four days, to fits of retching,
without any bilious difcharge ' or pain in
the ftomach ; and except -a white tongue, he
had no fymptom of fever in that time, nor
any thing to prevent him from doing his
duty. On the fourth day, when I firft faw
him, he began to complain of a fixed pain
P d 4 in

4P8 OBSERVATIONS »A*T III,

ia the pit of the ftomach, which was not
very violent, .and about the fame time a
yellownefs began to appear on the white of
the eye. He took a laxative medicine,
which had the defired effect, and fome vola-
tile fpirits, with fome drops of thebaic tinc-
ture in fimple mint water, for the pain in
his ftomach. He had a good night. Next
day the complaint of the ftomach was bet-
ter ; but there was great mivfcular debility.
He had feveral natural ftools ; and as there
feemed little indication but debility, he took
nothing that day except an infufion of fome
bitters and aromatics in wine. As he did
not want for appetite, he eat fome broth
and chicken ; and nothing to give any alarm
happened this day, except a fhort qualm,
in which he was faint, with a fenfe of cold,
feeling to himfelf, as he faid, as if he
fhould have expired. In the afternoon he.
began to have black- coloured ftools, which
was the firfl fymptom that clearly betrayed
the nature of the difeafe. He was then or-
dered as much Peruvian bark as he could
take with red wine, and thefe his ftomach
bore. Decodtion of bark was alfo given

him

CltAP. I. OF fBT-U'fcS. 40^

him in clyfters. He had a ft-rong voice,
and was quite fenfible, but grew weaker
and weaker with frequent returns of the
qualms, and he expired that evening before
ten o'clock.

I have not the leaft hefitation in ranking
this cafe with the fevers laft defcribed,
though fo many fymptoms were wanting.
This gentleman, though of a lively, active
difpofition, was of a {lender make, and of a
dingy, doughy comple&ion, and his cafe
gave me the idea of a difeafe attacking a
conflitution which, not having powers to
ftruggle with it, is overwhelmed without
making refinance*. In thofe robuft, pie-'

* I have been very cautious of admitting any theory
into this work ; but I cannot help adopting the do£trine
of my much-valued mailer Dr. Cullen, on this point—*
that a great part of the fymptoms of fever arife from re-
action, or that effort which nature makes to overcome
the morbid caufe. I am happy in any opportunity of ac-
knowledging my obligations to this learned profeflbr, to
whom the medical world in general is fo much indebted,.
as well for the rational views of the animal ceconomy,
which he teaches, as for that fpirit of ftudy and inquiry
which he infufes into the minds of his pupils.

thoric

4m OBSERVATION* ?AHT IU«

thoric habits, which are mofl commonly at- -
tacked, there is a fumxient degree of ftrength,
to excite the violent fymptoms before enu»
merated.

A few days after this gentleman's death,
another officer of the fame fhip was taken ill
with the fame fort of fever, and it was alio
attended with feveral unufual fymptoms,
Neither his fkin nor eyes were yellow ; the
fkin was hot and dry throughout the dif* ■
eafe, and during the three firft days there
was a diarrhoea, which was neither bilious^
putrid, nor mucous, but confifted in wate*
ry floolsi There were no gripes, nor any
local pains whatever; but I never remem?
ber to have feen more fufFering from that
general anguifh, particularly about the fto*
mach, which attends this fort of fever. On
the third night he began to vomit and purge
blood, which foon terminated in that dark-'
coloured difcharge which is a fymptom fo
chara&eriftic and fatal in this difeafe. He;
continued fenfible till within eight hours of
his death, which happened on the fourth
night. The pulfe was full and 'pretty

ftrong

CHAP.X» ON FEVERS. 4**,

ftrong during the whole cour-fe of thedif*
cafe ; but there was all along great debility
and frequent llghing, iymptoms that ought
always to create alarm.

Treatment of the Yellow Fever.

I FEEL this as the moil painful and
difcouraging part of this work, the yellow
fever being one of the moft fatal difeafes to
which the human body is fubjeft, and in
which human art is the moft unavailing.

It feems hardly to admit of a doubt that
there are particular inftances of difeafe, in
their own nature, determinedly fatal, that is,
in which the animal functions are from the
beginning fo deranged, that there are no
pofiible means in nature capable of control-
ling that feries of morbid motions which
lead to diflblution. Of this kind appear to
be the greateft number of cafes of the
plague, many of the malignant fmalJ-pox,
and fome of fevers, particularly of that kind
now under confideration. It is extremely

difficult

412 OBSERVATIONS FART Hi,

difficult to ascertain fuch cafes from obfer-
vation ; and it may be faid that the opinion
of the exiftence of them is favourable to
ignorance and indolence. But, on the other
hand, it may be queftioned if more harm
is not done in medicine, by being too fan-
guine and officious, than by a diffidence of
art and trufHng to the powers of unaflhted
nature ? Were we thoroughly acquainted
with the animal ceconomy, we mould per-
ceive a priori in what inftances the feeds of
difeafe would either operate fo as neceffarily
to terminate in death, or when they were
within the command of art. But we can
derive little or no information from this
fource, on account of our great ignorance
of the fecret operations of the living body ;
fo that the only grounds of judging are our
obfervation and experience concerning the
ufual event of difeafe, and the effects of re*-
medies. Though thefe are circumstances
attended with great uncertainty and ambi-
guity, yet I believe it will be admitted as
the opinion of the moft chafte and expe^
rienced obfervers, that there do really exifl:
difeafe s whole courfe cannot be diverted by

any

CHAP. I. OK FEVtRS, 413

any means that can be employed. This
opinion, I have faid, is, in one view, ex-
tremely difcouraging ; yet, to the mind of
a feeling and confcientious practitioner, who
muft often find his beft endeavours baffled
in many difeafes as well as this, and who
might be apt to look back and aceufe him-
felf of fome fault or omiffion, it affords
this fatisfaction to his reflections, that the
want of fuccefs may have been owing to
fomething in the nature of the difeafe, and
not to his want of Ikill and attention.

But though the fatality of this diieafe is
difcouraging, let us not defpond, but rather
redouble our diligence in obferving what af~
iiftance and relief nature may admit of.

It is proper in this as in every other fever
of this climate, to begin the cure by clean-
fing the firfl: pafTages. This does not pro-
duce the fame relief as in the common bili-
ous fever, probably becaufe there is a lefs
free fecretion of bile, and therefore lefs op-
predion from the colle&ion of it.

With

414 OBSERVATIONS PART III,

With regard to blood-letting, th« moil
that cari be faid in its favour is, that if
there mould be a hard throbbing pulfe, with
violent pain in the head and back, it is fafe
in the flrfl twelve hours. This holds, at
Ieaft, with regard to common feamen, who
do not bear evacuations fb well as officers
and others, who are ufed to a better diet,
and to whom the lofs of blood has, in fome
cafes, been found ufeful in a very early ftage
of this fever. It is, however, in all cafes
extremely dangerous, except in the circum-
stances mentioned above. The blood is faid
generally to (hew a buff; but thiis alone,
without confidering other circumftances in
the appearance of it, does not always argue
the propriety of blood-letting *.

The great object in the cure of this fever
is, to bring the flomach to bear the bark#
There are here wanting, moft of the circum*

fiances

* There is a difference in the appearance of the blood
when fizy, perhaps not fufficiently infilled on by practi-
cal writers; for though there fliould even be a very
thick buff, yet, if the furface is fiat, and the crafjamen-
tum tender, no great inflammation is indicated, in com-

2 parifon

CHAP. I. ON. FEVERS. 415

fiances that in the other cafes forbid the
■u fe of it ; for there is no preternatural
quantity of bile in the ftomach and intef-
tines, nor is there a hot and dry fkin, nor
violent delirium. The only obftacle to its
administration is the great irritability of the
ftomach, which is tne moft fata.l fy mptom
of the difeafe ; and the principal part of the
management of the patient conlifts in the
prevention or removal of this. The (to-
mach is to be treated with the utmoit ten-
dernefs and attention. One gentle emetic
at. the beginning is all that is allowable ;
and as frefh collections of bile are lefs apt
to occur, the repetition of it is lefs ne-«
ceffary.

It is beft to abftain altogether from anti-
monial medicines, and to render every thing,

parifon of that ftate of the blood wherein the furface is
Cupped, the craffamentum contracted fo as to afford the
appearance of a large proportion of fcrum, and where it
feels firm and tenacious, though perhaps but thinly
Covered with buff. This is a diftinction well worth at-
tending to in practice; for it is in thefe laft circumftances
that blood-letting gives moft relief, and where the pa-
tient will bear the repetition of it with moft -advantage. :

whether

4t6 OBSjlVAf IOK$ PART UU

whether food, drink, or medicine, as grate*
ful as poffible. The liquid mod apt to ftay
upon the ftomach is the juice of the acid
fruits of the climate, fuch as * oranges and
lemons. It happens frequently, however,
that acids come to be loathed extremely, fo
as to nauieate the ftomach and to encourage
retching. In this cafe I have found a com-
pofition of wine and water with lemon juice
and nutmeg, fweetened with fugar and given
warm, to be a very grateful and falutary
drink. The patient fometimes prefers the
decoction of farinaceous fubftances to every
other drink ; and in one cafe in particular,
which did Well, the patient was led by tafle
to prefer warm water gruel to every thing
elfe, and the great quantity he drank feemed
to have a confiderable fhare in the recovery,
by keeping up a warm moift ikin and pro-
ducing a great flow of urine.

In order to check vomiting, the faline
draught, in the act of effervefcence, has been

* See the fame ohfervation in Mr. Hume's EiTay on
this Difeafe, published by Dr, Donald Monro.

employed

CHAP. I. ON FIVE R S» 417

employed with evident advantage ; but in
moft cafes this fymptom is fo obftinate as
to difcourage all attempts to remove it. I
have known magnefia in mint water have a .
vifible effect in foothing the ftomach, parti-
cularly when given immediately after fome
acid beverage.

I was informed by Dr. Young, phyficiari
to the army, that he found an infufion of
chamomile flowers one of the bell: medicines
in this vomiting ; and a furgeon of one of
the line-of-battle mips informed me, that he
alfo found advantage from it in alleviating
this lymptom. I have feen good effedts in
cafes of obftinate vomiting from fomenting
the ftomach with ftupes wrung from the de-
coction of bark, and fprinkled with campho-
rated fpirits and tincture of bark *.

* The ftate of the ftomach is very much affected by
that of the external furface of the body ; and it is faga-
cioufly obferved by Sydenham, that the ftomach being
commonly very irritable in the plague, the moft effectual
means of making it retain what was adminiftered inter-
nally was to excite a fweat.

E e But

418 OBSERVATIONS tAHTUU

But nothing had fo great an effecT: in re-
moving this irritability of jftomach as a blif-
ter applied to the external region of it ; and
it is a remedy which, fo far as I know, has
not been hitherto recommended. In other
fevers, when the head was not particularly
affected, I preferred this place for the appli-
cation of a blifter ; for it is in lome refpects
more convenient than between the moulders,
and the jftomach is the part more affected
perhaps than any other in all fevers. But
in this fever I was led to apply it to this
part, both from its being affected in an un-
common degree, and from obferving, upon
infpecting the bodies of thofe who died,
that the only morbid appearance that could
be difcovered was an inflammatory fuffufion
on the inner membranes of the ftomach.

I have employed opiates both externally
and internally to allay this fy mptom, but
without the effect that might have been ex-
pected from fo powerful a fedative.

As the ftomach will feldom, even in the
mod favourable cafes, bear fuch a quantity

*HAP. I. QN FETERI. 4*9

of bark as to fubdue the difeafe, it muft be
exhibited in every other way that can be
thought of, fuch as by clyster and by ex-
ternal fomentation, both of which I have
employed with good effect. I ufed to or-
der a pint of decoction of bark to be in-
jected every two or three hours, and the
fomentation to be employed nearly as often,
I have heard of the decoction of bark being
ufed as a warm bath with fuccefs ; but I
have no experience of this practice myfelf.

I have no other internal remedy to recom*
mend ; for whatever power the ftomach has
fhould be employed in taking in bark. If it
Should become tolerably retentive, camphor
will be found of fervice ; and if given in
the evening with an opiate, perfpiration and
fleep will probably be procured, by which
the patient will be greatly relieved.

Blifters to the thighs and legs feemed to
coincide with the general intention of cure,
and they appeared to be of advantage in the
cafes in which they were tried.

Ee ? a. Of

420 OBSERVATIONS PART HI,

4. Of the Effects of Flowers of Zinc and
White Vitriol in the Cure of obftinate
Intermittent Fevers.

IT frequently happens in the Well: In-
dies that intermittent fevers are fo obftinate
as to refill: the common means of cure by
the Peruvian bark ; fo that thefe complaints
become extremely diftrefting to the medical
practitioner as well as to the patient. In-
deed this was a difficulty that occurred fo
often, that I was fometimes tempted to
think, either that the great reputation of this
medicine is not fo well founded as is com-
monly believed, or that the bark generally
in ufe in thefe times is not of fo good a
quality as that employed hy the phyficians
who firft eftablifhed its character.

But, in the firft place, the experience upon
which its reputation was firft built was i-n a
temperate climate, where very few agues,
are found to refill it when properly admini-
ftered. In the next place, there is reafon to

believe

CHA?. ?. O N F E Y B R S« 42*

believe that, in fact, the medicine itfelf now
commonly in ufe is not equally powerful
with what was firft employed j and a fpe-
cies of it, called the Red Peruvian Bark,
has lately been difcovered, or, perhaps, ra-
ther revived, which is certainly of a fuperior
quality, and has been found to cure inter-
mittents in which the common fort had
failed *.

However this may be, it is an undoubted
fact that obftinate agues are much more fre-
quent in the Weft Indies than in Europe ;
and fomething to fupply the infufficiency of
the bark feemed to. be a defideratum.

I was informed by Dr. Hendy, of Barba-
does, that he had found the flowers of zinc
to anfwer in cafes of intermittent fever, in

* The red bark was brought to England in a Spanifli
prize in the year 178 1, and a very accurate account of
its medical and chemical properties was published the year
after by Dr. William Saunders of Guy's hofpital. None
of it had been brought to the Weft Indies before the
peace, fo that I had no opportunity of trying it in that
climate.

E e 3 which

4*2 OBSERVATIONS PART UU

which even the bark and every other remedy
and mode of treatment had failed. It was
found very fuccefsfui in the like cafes, both
in my own trials at the hofpitals, and by
the furgeons of the men of war to whom I
recommended the ufe of it. In order to
judge what may be expected from it, I (hall
give a fpecimen of its fucceis in fome cafes*
at the hofpital at St. Lucia, of which I kept
an accurate account, in the months of Fe^
bruary and March, 1783.

About the time the fleet arrived there,
fix cafes of intermittent fevers were fent to
the hofpital from different fhips. One was
of fix weeks continuance, and had been
fometimes of the tertian, fometimes of the
quartan type. Two were quartans ; one of
which was of two months, the other of
eight months duration. Two were regular
tertians ; of which one had only had two
fits, but was a relapfe after a week's exemp-
tion from an attack of feveral weeks. The
other was of three months continuance, at-
tended with an eruption on the hands and
arms. The fixth cafe was a quotidian of
2 three

CHAP. I. ON rETElS, 423

three weeks, attended with a cough of the
fame landing, and joined with fea fcurvy.

In all of them the bark had been given
at fome period or other ; and the flowers of
zinc were now tried in all, except the laft.
Jn three out of the five this medicine had
the mod vifible good effe&s. In one the
difeafe was fo fpeedily removed, that there
Was only one fit after the firft day of taking
this medicine, and the other two had reco-
vered perfectly after the ufe of it for fevm
days.

In thefe cafes there can be little or no
ambiguity with regard to the real efficacy of
the medicine, as the difeafe had lafted from
two to fix months, and there was no other
circumflance of change in the fituation or
treatment of the patients that could account
for their recovery,

Of the two cafes in which it failed, one
was the tertian of three months, attended
with the eruption ; the other was the re*
lap fed tertian of three days,

Ee 4 With

4^4 OBSERVATIONS PART 111,

With regard to the dofe, I began with
giving it in the quantity of two grains
thrice a day, which, in fome, produced the
defired effect, and without the leafl fenuble
operation on the ffomach or bowels. If
this dofe did not ftap the fits after a few
days trial, it was increafed to three grains,
which, in fome, would produce a little fick-
nefs. I found that four grains ruffled the
ftomach a good deal ; but if the patient is
gradually habituated to it, even more than
this may be given without inconvenience.

In thofe cafes in which it was fuccefsful
it was not found neceffary to give more than
two grains at a dofe, except in one of them,
in which three were given the day before
the fit ceafed. ^ In the two unfuccefsful
cafes the medicine had a fair trial for a fort-
night ; but one of them getting no better,
and the other feeming to get worfe, it was
left off.

The cafes to w7hich this medicine is
adapted are thofe that have extremely dif-
tinct remiffions, with no iymptoms of bile

nor

nor any local affection. When agues come
to be long protracted, they are frequently
what may be called nervous ; that is, con-
fining of certain morbid motions that feem
to be induced by habit, after the original
cauie is removed, and with a tolerable en-
joyment of appetite, fleep, and all the func-
tions of life, during the intermiffion.

The two cafes in which the zinc failed
recovered by the ufe of the bark. This
had been unfuccefsfully tried before, and its
good effects now might either depend on its
having been left off for fome time, whereby
the body recovered its fenfibility to ks vir-
tues, or it might be in confequence of ad-
miniftering it in ardent fpirits with a few
grains of capficum and ginger, additions
which I found to improve its effects in other
cafes, and is a mode of giving it well fuited
to this climate.

The zinc was not tried in the fixth cafe,
on account of the local affection and the re-
miffion being fhort and imperfect,

Thd

4*6 OBSERVATIONS PART III.

The white vitriol, being a fait of 2inc,
might be fuppofed to poffefs the fame vir^
tues ; and it would appear to do fo from
fome fads * that were reported to me in the
Weft Indies, and alfo from fome trials made
by me at St. Thomas's hofpital fince I came
to England,

* Mr. Telford related to me, that he had cured feve-
ral intermittents that had baffled the bark, by means of
white vitriol, whilft he was furgeon of the Yarmouth h\
1779. He gave it in doles of five grains every four hours
In the intermiflion, and was fuccefsful in every cafe ex-
cept two in which the patients were far advanced im
the dropfy.

He met with feveral cafes of the fame kind in the AI-
ctde, in 1782, in which he was fuccefsful with the flowers
of zinc, after having given large quantities of bark to no.
purpofe. He preferred, however, the white vitriol, as
being milder in its operation, and lefs apt to difagree with
the patient's ftomach.

He did not employ either of them in the recent ilate.
of the difeafe, nor does he give them as univerfal or in-.
fallible remedies; but only alledges, that he has expe-
rienced the rnofr. evident good effects from them in an
advanced ftage of the difeafe, and a reduced ftate of the
patient, where the common remedy had failed.

Though

CHAP. X. OH FEVERS, 4^

Though this is a medicine of very confi-
derable powers, I do not mean to put it in
competition with the bark, by propofing it
as a fubftitute for it, or by reprefenting it
as fuperior to it in all circumftances ; but
only to propofe it as a valuable fubfidiary in
particular cafes. The account I have given
is faithfully extracted from a diary of my
prance ; and were I to fay more in its fa*
vour than the future experience of others
may warrant, I mould do more harm than
fervice to its reputation. Many good medi-
cines have had their characters hurt by be*
ing over-rated by the firft: propofers of them,
who are naturally fanguine and partial, with-
out, perhaps, intending to deceive. But
when others find that their virtues do not
come up to what has been aflerted, they are
apt to run into the other extreme, and ex-
plode them altogether ; fo that what was
given out as good for every thing, is now
found to be good for nothing *.

* Dr. Huck Saunders, whofe recent lofs the world has
yeafon to regret on account of his experience and fagacity
as a phy fician, as well as his virtues as a man, communicated
to me, in converfation, Come obfervations on the cure of

obftinate

4*8 OBSERVATIONS PART III.

<?>bftinate intermittent s, which deferve to be mentioned
here. When he was phyfician to the army at the Ha-
vannah he cured a number of agues which had refilled
the bark, by giving two ounces of the vinous tincture of
rhubarb and fix drams of the tincture of fena feven or
eight hours before the fit. This being repeated two or
three times, carried off the difeafe. He alfo informed
me, that he had met with agues in England which did
mot yield to the bark ; but, up©n leaving it off, and put-
ting the patients on a courfe of mercury, they were cured
upon returning to the ufe ©f the bark*

I mall here mention another unufual remedy in inter-
mitting fevers, and though I can bring only one inftance
in proof of its efficacy, yet this is fo ftrong as to make
it deferve farther trial. A man on board of the Sand-
wich had an ohftinate intermittent which had refitted the
bark, and was flopped by applying to the ftomacha;
plafler compofed of gum plafter, epifpaftic plafler, and
eptum^ in proportions which I do not now recoljeft.

CHAP.

CHAF. II0 ON FLUXES* 4$'f

CHAP. II.

Of Fluxed

A HESE feem to arife in the fame cii>
cumftances, and to be owing to the fame
general caufes, as fevers. They may, in
ibme fenfe, be confidered as fevers, attended
with peculiar fymptoms in confequence of a
determination to the bowels, juft as fevers
in cold climates are fometimes attended with
rheumatifm or catarrh. We have feen, in
the firfb part of this work, that the dy fen -
tery arofe chiefly in thofe iliips which had
been fubjeft to fevers.

This determination to the bowels is owing
to a variety of caufes, but is chiefly connec-
ted with external heat ; for it is mofl com-
mon in hot climates, and towards the end
of fummer or in the autumns of cold cli-
mates, owing probably to a greater acri-
mony of the fecretions of the inteftines,

and

43& OBIERVATJOHJ *ARf lit.

and particularly of the bile. Dyfenreries
arife in camps alfo at the fame feafons, and
in the fame circumftances as bilious fevers**,

Befides climate and feafon, the other cir*
cumftances determining to the one difeafe
more than the other are, I. A difference in
the constitutions of different men ; for in
the fame fhip it fometimes happens that
both difeafes prevail equally, though all the
men are ufing the fame diet and breathing
the fame air. 2. The nature of the occa-
fional caufe. A dyfentery, for inftance, is
more likely to arife from an irregularity in
eating or drinking ; a fever from being ex-
pofed to the weather, particularly marfh ef«
fluvia. 3. The particular fpecies of infec-
tion that may happen to be introduced.
Suppofe, for example, that a (hip's company
is predifpofed to acute diftempers, and one
man or more ill of the dyfentery fhould be
brought on board, this will become the pre«
vailing difeafe, as happened in the Torbay
in Auguft, 1780. If the like number of

* Sir John Pringle on the Difeafes of the Army.

fevers

CHAP. II* ON rtUX'ES.' 43I

fevers fhould be introduced, then fevers
will be the prevailing difeafe.

Thefe two difeafes may therefore be con-*
fidered as vicarious, the one fubllituting it-
felf for the other according to particular ac*
cidents, and both proceeding from the fame
general caufes ; and this is no new idea of
mine, but feems to have been Dr. Syden-
ham's, where he calls the dyfentery zfebrk
intr&verfa. It may be farther added, that
dyfentery is the fafeft form in which this
Caufe, which is common to both, can exert
itfelf ; for it is a difeafe more within the
reach of art ; and fome of the moil dange-
rous fymptoms attending fevers, particu-
larly delirium, feldom occur in dyfentery*
When it proves fatal, it is in confequence
of violent local affe&ion, and that in general
after it has taken a chronic form. When
an incipient fever turns into a dyfentery, all
the fymptoms, and particularly the head-
ach, delirium, and coma, if there fhould be
any, are immediately relieved. And the
moll: favourable cafes of the yellow fever are
thofe in which a bilious diarrhoea comes on,

while

OBSERVATION* PART IIX.

while the moil fatal are thofe in which tho
bowels are fo torpid as to be infenfible to any
flimulus either from their own contents or
from medicine*

I {hall not enter into a minute defcriptiori
of this difeafe in all its flages, as this has
been fo ably executed by Sir John Pringle,
Sir George Baker, and other authors, but mail
only give a fketch of fome of the moil re-
markable fymptoms, particularly fuch as are
peculiar to the climate and manner of life, fo
as to explain the varieties that may be necef-
fary in the mode of treatment.

The fluxes that arofe in the fleet were ei-
ther what may be called the acute idiopathic
dyfenteries, or a dyfenteric ilate of the
bowels from neglected diarrhoeas, which
was moil apt to occur in the convalefcent
ilate of fevers, or in men labouring under
the fcurvy. The body is more fufceptible
of infection in a ilate of weaknefs, from
thefe or any other caufes ; and in hot cli-
mates the dyfentery feems to be more infec-
tious than fevers; for at hofpitals it was

GHAP. II. 0 N F L U X E S. , 433

fo frequently communicated to men who
were ill of other complaints, that it was in
thefe the principal caufe of mortality. For
this reafon, I was at more pains with regard
to this difeafe than any other, in keeping
thofe who were ill of it in a feparate ward. .

I have met with fome violent and untrac-
table cafes which proved fatal in the acute
ftate ; but, in general, this difeafe draws
out to a chronic form in this climate, and
does not prove mortal for many weeks.
The ufual caufe of death appears, from the
infpection of the bodies, to be an ulceration of
the great inteftines, particularly of the de-
fending colon and the rectum. This part of
the inteftinal tube is moil affected from its
being the receptacle of all the acrid feere-
tions from the reft of the canal ; and it is
naturally more fubject to congeftions of the
fluids and incurable ulcers, as appears from
the rectum being fo liable to the hemor-
rhoids and xhzfijlula. Thrs ulceration of the
great inteftines is fo common, that out of
eight cafes which I infpected after death,
feven had this appearance. The cafe in
F £ which

OBSERVATIONS PART IlTi

which there was none was not fo much a
cafe of dyfentery as ©f inflamed bowels,
brought on by the man having drank to
excefs of fpirits while he was recovering,
from a dyfentery. The acute tormina which
always occur in the fkft. days of the dif-
eafe feem owing to an inflammation, which
terminates in ulcers ; and thefe being con-
ftantly irritated by the (harp humours, pro-
duce the tmefmm, which is the fymptom
moll: efTential to dyfentery in the after part,
of the difeafe. Any diarrhoea may in this
manner become dyfenteric. During the
acute griping at the beginning, the ftools
are loofe and copious ; but as ibon as the
tenefmus takes place, they are fcanty, which
is moft probably owing to the fpafmodic
flrietures in the great inteftines, in confe-
quence of irritation upon their excoriated
furface. The inflammatory Hate is more
kiting and violent in a cold than a hot cli-
mate, the gripings are more fevere, and the
danger is alfo greater in this ftage of it.

The ftate which the great inteftines fair
into in old dyfenteries, feems to have fbme-
thing in it peculiar to itfelf : the feverai

coats

fcHA*. tit ON F L U X £ S. 435

coats become thick and fpongy ; their tex-
ture is obliterated and deftroyed ; and they
become of a black or very dark purple co^
lour. This, however, cannot be called mor-
tification ; for the fibres of the gut do not
lofe their tenacity, nor is there that putrid
and diflblved ftate in which gangrene con-
lifts ; but it advances in time to fuch an ex-
treme ftate of difeafe as to be entirely inca-
pable of recovering its natural appearance
and functions, and proves therefore the caufe
of death*

The greater frequency and obftinacy of
thefe chronic fluxes in hot than in cold cli-
mates* feems to be owing to the fame wea-
kening of the powers of life which make
recovery in general fo tedious, and particu-
larly that of wounds and ulcers. The
greater quantity of acrid bile will alfo tend
to keep up the ulceration* Dyfenteries have
this disadvantage, that the Peruvian bark,
which is the moll: powerful reflorative in
other complaints of this climate, is here
found to be inadmiflible on account of the
heat, thirft, and other febrile fymptoms,
F f i which

43$ OBSERVATIONS

PART nr*

which it is fure to induce in all fbges of
this difeafe.

Treatment of Fluxes.

THERE are few difeafes in which a
prudent application of art is more ufeful,
or in which early means of relief are more
requifite than in this *.

Where the dyfentery is the original dif-
eafe* and when the patient is robuft and ple-
thoric, with acute pain and a flrong pulfe,
blood-letting may be praclifed with advan-
tage in the beginning of the complaint.
But there is no part of the practice in this
difeafe in which the climate and manner of

* This is elegantly exprefTed as follows, in Sir George
Baker's learned Differtation on this difeafe : " Primo
St negledtus tradtatu afperior occurrebat : etenim corpus
(< extenuatum atque confeclum ut morbo fervido irapar
u erat, ita ipfi. impar curationi. Itaque optimum erat oc-
«' currere ipfis principiis atque auxilia mature preripere.
" In hoc enim corporis affeclu aliquod certe in medicinal
fi opus ell haud multum in naturse benefkio."

life

'CHAP. II. O N F L U X E «. 437

life makes a greater difference than in this ;
, for in a temperate climate it frequently hap-
pens that repeated blood-letting is neceffary ;
but in a hot climate, where the fibres are re-
laxed, and in the conftitutions of feamen,
whom we feldom or never find plethoric,
the inflammatory fymptoms requiring this
evacuation do not run fo high, nor continue
$0 long*

It is in ail cafes of the utmoft confequence
to adminifter as early as poffible a brifk fa-
line purgative. An ounce and a half or two
ounces of purging falts may be diffolved in
a quart of barley water or water gruel, and
given warm in cupfuls, at fmall intervals,
till a free and copious evacuation is pro-
duced. If there mouLd be much fever, or
licknefs at ftomach, two grains of emetic
tartar will be a great improvement of this
medicine ; and there will be this farther
advantage from its ufe, that if the ftomach.
ihould be loaded with bile, in which ftate
it is more irritable, an evacuation upwards
will alfo be excited to the great relief of the
.patient.

F f 3 This

43$ OBSERVATIONS f ART lit,

This early and feafonable meafure will,
in many cafes, put a ftop.to the difeafe,
efpecially if the patient is thrown into a
fweat immediately after the bowels have
been thus thoroughly evacuated. It is of
great fervice in this difeafe to promote free
perforation, and even a plentiful fweat,
which may be effected with great advantage
by giving, at bed time, a medicine com-
pounded of opium, ipecacuana, and a little
neutral fait, accompanying it with plentiful
warm dilution. Nothing tends more to re-
lieve griping and tenefmus than a general
warm moifture on thefkin. The ipecacuana,
which is an ingredient in this medicine, is one
of the beft anti-dyfenteric remedies we know ;
the opium procures reft 5 and this, joined to
the fudorific effect of the whole, not only
gives a temporary relief, but tends to carry off
the difeafe. It is moll properly given in the
evening ; for there would be this inconve-
nience in conftantly encouraging a fweat,
that if the tenefmus mould return, it would
either be checked by the patient getting fre-
quently out of bed, or there would be dan-
ger of his catching cold, I am well aware
I that

-CHAP. II. Q N V L U X E S. 439

that we cannot be too cautious with regard
to the ufe of opium in the beginning of
this difeafe ; but it is admiffible more early
m a hot climate than a cold one, as the in-
flammatory fymptoms are lefs violent and
fooner fubdued ; besides, it becomes an en-
tirely different medicine when conjoined
with the other ingredients that have bem
mentioned.

The beft- medicine in the day time we
found to be fmall dofes of ipecacuana alone
twice or thrice a day ; and if there mould
ibe frefh collections of bile, fmall dofes of
the faline purgative will be neceffary. Ipe-
cacuana, in this intention, may be given in
the dofe of two grains in .athletic conftitu-
tions, fuch as thofe of fearnen ; but in the
more delicate conftitutions, fuch as are com-
monly met with in private practice, one
grain is a fufficient dofe. I have found
manna and tamarinds a good addition to this
medicine in the earlier ftages of the difeafe,
where there was much bile ; but in a more
advanced ftage of it they are apt to produce
gripings and flatulence.

F f 4 The

44® OBSERVATIONS PART lit.

The marks of a redundance of bile are, a
ficknefs at ftomach, a fenfe of fcalding at
the anus when the ftools are pafling, and
the yellow or green colour of the ftools
themfelves. It is apt alfo to excite fymp-
toms of fever, fuch'as a foul tongue, a hot
and dry fkin, with thirfl:. When collections
of it are fufpected in this difeafe, it is beil
to evacuate it by vomiting, for it is thereby
prevented from irritating the bowels, and
from arriving at the inflamed parts with,
perhaps, increafed acrimony, acquired in
pafling through the whole length of the
inteftines.

Some gentlemen of the fleet informed me
that they found oil of almonds a ufeful addi-
tion to the purgative. Others as well as
myfelf compared the fa-line purgative with
that compofed of rhubarb and calomel, as
recommended by Sir John Pringle, and we
gave the preference to the former, as more
eafy, fpeedy, and effectual in its operation,
efpecially in the firft ftage. Cafes may occur,
however, in which the other may be more
advifable ; for where there is a fenfe of

weight

9HAP. IX. ON F L U X E S„ 44-t

weight about the ftomach* which moft. pro-
bably arifes from the biliary organs being
clogged with bile, and where emetics have
failed to remove it, or the weaknefs of the
patient may render them improper, then ca-
lomel has the befr. effect : far it was for-
merly obferved, that it tends to loofen the
fecretions, and to Stimulate the more diftant
excretories, fuch as the biliary duds.

It is very important to caution young
practitioners concerning the employment of
opium in all flages of this difeafe, but efpe-*
dally in the beginning ; for though it is an
excellent remedy when feafonably and judi-
ciously employed, it is very liable to abufe,
particularly in the hands of the inexpe-
rienced, who may be tempted to give it im-
properly from an anxiety to relieve; but as
more harm may arife from an unfeafonable
administration of it than could be compen-
fated by the beffc-timed ufe of it, it is belt
to err on the fide of caution and omiffion.
The principal caution to be obferved with
regard to this remedy is, to premife fuit-
able evacuation, fuch as blood-letting, if ne-

ceffary,

44* OB S E R V A T * O N 3 TART HI.

l|Mary, but more efpeeially purging. It
is always pernicious to give it in its pure
ftate during the iormina, fo common in the
£rft days. By thefe I mean the abdominal
gripings, which denote inflammation, and
are entirely different from the tenefmus,
which is a more conflant and chara&eriftie
fymptom of the difeafe, and feemS to arife
from irritation and fpafms of the' rectum
and colon.

It was in this difeafe that I fir ft obferve^
the good effe£ts of a fmall quantity of neu«
tral fait in taking off the ineonveniencies
attending opium, fueh as the fevenfh heat
and confufion of the head, which it h apt
t® produce in many conftitutions g and as
the adminiftration of the anodyne coincided
with the evening dofe of ipecaeuana, I was
led to adopt a form fimilar to that of Pover's
powder, but with only half the quantity of
opium ; or, it was given in a liquid form, by
combining twenty drops of thebaic tincture
and a drachm of ipecaeuana wine, with nitre
from five to ten grains, in any fimple vehi-
cle in form of a draught. There is a very

obfer-

CHAP. II. ON FLUXES. 443

obferveable difFerence, in fome cafes, be-
tween opium, given in a liquid and in a folid
form ; and the former is much more certain
in its effect when the intention is to procure
fpeedy and effectual eafe.

I have obferved great benefit from the ufe
of external remedies in dyfentery, and thefe
have, perhaps, been too much neglected by
authors and practitioners. The warm bath
is of great fervice, efpecially where the
gripes and tenefmus are fevere, and where
the fever has been taken off by previous
evacuation. Fomentations or warm appli-
cations of any kind to the abdomen give
{temporary relief, and it will be found of
advantage to keep thofe parts, at all times,
well defended from the cold air. Bliflers to
the abdomen were alfo found of ufe, and
likewife acrid liniments, compofed of oil,
volatile fpirits, and tincture of cantharides.
Where the ftomach has been much affected,
I have perceived relief from fomenting it
with ftupes.j upon which thebaic tincture
and camphorated fpirits were fprinkled, as
recommended by Dr. Lind. I was once af-
fected

444 OBSERVATIONS PART III.

fected with a bad dyfentery in the Weft In-
dies, and I thought myfelf much relieved
by the warm bath and a blifler. Strangury
is not an uncommon lymptom in this dif-
eafe, independent of cantharides, and the
mofl fenfible and effectual relief is derived
from fomentations to the pubis and peri-
naeum, as I alfo experienced in my own cafe.

What has been hitherto faid regards
chiefly the acute dyfentery; but the moil:
frequent and trouble fome complaint that
occurred at the hofpital, was the fame dif-
eafe in what may be called its chronic ftate.

There is a confiderable variety of fymp-
toms in all the ftages of this difeafe, but par-
ticularly in the more advanced or chronic
ftate, fo that a correfponding variety is ne-
ceflary in the modes of treatment, and there
are few difeafes in which there is more room
for exercifing the judgement.

In all ftages of it an accurate difcernment
is neceflary with regard to the ufe of opiates,
and great part of the practice here confifts in

timing

CHAP. II. ON FLUXES. 445

timing thefe well. They are leaft admiffible
in the beginning, where evacuation is the
principal object, but as the difeafe advances
they become more and more allowable and
nfeful. The principal cautions necefTary in
their adminiftration are, i. To premife fuf-
ficient evacuation, fo that the inteftines may
not be loaded at the time with bile, fcyhala,
or any other irritating matter. 2. To obviate
the effects which anodynes have of caufing
a retention of the contents of the inteftines.
This may be done, either by giving fome-
thing purgative along with it, or after it has
produced its quieting eflecl:. I prefer the
former method, for as foon as the effect of
the opiate is over, the purgative is ready to
a£t, and in this way it is fo far favourable to
the operation of the purgative that large fe-
culent ftools will be difcharged ; whereas,
had the purgative been given alone, it would
have been more apt- to produce fcanty gri-
ping ftools, attended with tenefmus. Rhu-
barb anfwers well in fuch cafes, and may be
given in a dofe from twelve to twenty grains,
according to the age and conftitution. 3. To
prevent feveriih heat and delirium, this was
1 propofe4

44^ observations Part Hi.

propofed to be done in the firft ftage of the
difeafe, by combining it with ipecaeuana and
a little neutral fait. With the fame intent
tion, it may now be joined with a few grains
of Dr. James's powder, or vitrum ceratum
anttmonii, in which form it will not be fo
ftrongly fudorific, an effect: not fo much re-
quired in the chronic as in the acute ftate.

The principal caufes that keep up the flux*
and render it fo obflinate, are, 1. A too
great fecretion of bile, either continually
or frequently recurring. 2. Ulcers in the
great interlines. 3. A lienteric ftate of the
bowels. 4. A retention of fcybala.

The firft caufe is much lefs frequent than
might be expected by thofe who fancy that
every difeafe of this climate proceeds from
bile. When it does occur, there is more oc-
cafion for the employment of evacuant me-
dicines, and more caution in that of opiates.
A medicine that will difpofe the liver, or the
circulating fyftem in general, to form lefs
bile, is a dejideratum in phyfic ; but, in cafe
of an exceffive flow of it, emetics and mer*

curia!

CRAP. IT* ON FLUXES, 44 J

curial purgatives, as has been already men-
tioned, are the bell means of evacuating it ;
and care mould be taken that it be discharged
before it accumulates too much, or becomes
acrid by too long retention.

In order to obviate that Irritation in which
tenefmus confifts, great benefit was found
from the frequent injection of emollient and
anodyne clyfters, to waih off and dilute the
acrimony, and to Tooth and heal the parts.
A ftrong infufion or decoction of linfeed or
ftarch may firft be given to the quantity of
near a pint, to be evacuated after a fhort re*
tention, and then a few ounces of the fame,
with thirty or forty drops of laudanum, to
be retained for a length of time, in order to^
procure reft. Inftead of this laft, I have
known a fmall quantity of warm milk, with
fyrup of poppies, ufed with advantage in
private practice.

I was at firft tempted to think that a very
frequent injection of fuch clyfters would be
very ufeful, by warning and healing the co-
lon and rectum, and preventing farther ex-

ulceration

44$ OBSERVATIONS PART III*

ulceration. But befides the objection arifing
from the tendernefs of the parts which, in
fome cafes, renders the operation itfelf pain-
ful, I found that if they were given oftener
than once a day, they rather incrcafed the un*
eafinefs, and made the patient feel languid
and exhaufted ; fo true is it that no practical
rule can be eitablilhed from reafon alone
without being brought to the teft of expe-
rience. The rectum feems to have a pecu-
liar fenlibility, and a remarkable confent
with the whole fy item ; for a itool will in-
duce fyncope, or even death, in a Irate of
great debility. Clyfters may be pernicious,
even though they produce no evacuation of
feces ; and Sydenham has remarked, with re-
fpett to other difeafes, that their unfeafpnable
or too frequent ufe greatly debilitates and dif-
turbs the patient. When not abufed, how-
ever, they are of the moft eminent fervice
in this and other complaints.

Certain medicines, which have been called
Jheathhig, have been recommended to be
taken by the mouth. Of this kind are mu-
cilage, oil and wax. I have made trial of

mucilage,

CHAP. II# ON FLUXES* 445

mucilage, fuch as ftarch, without any fenfi-
ble effect, probably becaufe it lofes its quali-
ties by the powers of digeftion before it
reaches the part upon which it is intended to
act. With regard to oil, I "have hardly
enough of experience of my own to decide ;
but fome of the furgeons of the fleet inform-
ed me that they found advantage from com-
bining it with the purgatives. I was difcou-
raged from ufing it by finding that it was apt,
in the Weft Indies, to become rancid on the
ftomach, and, for this reafon, Ifeldom, in any
cafe, employed the caftor oil, which, though
produced in that climate, feems to anfwer
better as a medicine in Europe. But mice
my return to England I have ufed, with
great benefit, at St. Thomas's hofpital, a
medicine, compofed of tincture of rhubarb
and oil, in old dyfenteries, attended with
difcharges of blood. I took the hint of
this from finding it of great fervice in deep-
feated piles, as recommended by Dr. Grif-
fith *. It is neceflary to combine fomething

purgative

* In Dr. Griffith's form of his medicine for the piles,
fit. drachms of frefh-drawn linfeed oil are joined with two

G £ drachms

45° OBSERVATIONS PART III,

purgative with the oil, otherwife it might-
be altered by digefrion, or abforbcd, or might
become rancid by too long retention in the
firir. paffages. Wax is a body not changeable
by digeftion, and feems therefore well fuited
for the purpofe of meathing the bowels ;
and I have found advantage from the prepa-
ration of it recommended by Sir John
Pringle*, on the authority of Dr. Huck.
I have alfo feen confiderable advantage in
old fluxes, in St. Thomas's hofpital, from
the ufe of fpermaceti, given with an equal
quantity of conferve of rofes and half as
much abforbent powder, agreeably to a form
in ufe at that hofpital.

The climate has a great influence in pre-
venting thefe ulcers from healing, upon the
fame principle that it prevents the cure of ex-
ternal fores and wounds, fo that there are cafes

drachms and a half of the vinous tincture of rhubarb,
and given twice a day in a draught. I commonly ufed
oil of almonds at the hofpital. This may be confidered
as another inftance of thofe ufeful combinations of medi-
cines, which experience alon© fometimes difcovers. I
have found it of ufe alfo in other internal haemorrhages.
* See Difeafes of the Army, p. 273. 6th edit*

that

CHAP. II. ON P L V X E S, 451

that admit of no cure but from a change of
climate. I have feen in fome cafes of old
dyfentery, fmall, round, ill-conditioned. ul-
cers break out on the furface of the body,
which feemed to proceed from the fame gene-
ral habit that produced thofe of the inteftines.
There was fomething peculiar in the appear-
ance of thofe external fores, being like fmall
round pits, as if a part of the fkin had been
removed by cauflic, and with little or no
difcharge. Iu a cafe of this kind, which
proved fatal, I found the whole furface of
the great inteftines befet with fmall ulcers,
not unlike thofe on the fkin.

The next caufe that was mentioned of
the long continuation of fluxes, was a lien-
teric ftate of the bowels. This confifts in a
great irritability of the whole alimentary
canal, whereby all the ingefia are tranfmit-
ted fo fair, that there is no time for affimi-
lation. Liquid aliment, fuch as broth, is
particularly fubje£fc to this inconvenience.
There are few cafes of long protracted fluxes
in the Weft Indies without this fymptom in
fome degree.

G g 2 The

452 OBSERVATIONS PART III,

The remedies tbr»" ve here found of mod
fervice are fuch as counteract irritability or
relaxation. It is in cafes where this is the
prevalent fymptom that opium may be moil
freely ufed. F^quent and fmall dofes of
the compound officinals. fuch as theriaca,
pulvis e bolo' compofitus, or diafcordium,
have been found of fervice. Though the
relaxation would feem here to indicate the
Peruvian bark, yet I never knew it em-
ployed in any form in this or any other ftage
of the difeafe without being hurtful. But
there are other bitters not only fafe but ufe-
ful in refloring the tone of the bowels ;
of this kind are flmaruba, quafiia, and cha-
momile flowers. The firfl has been rec-
koned a fpecific in- this fort of flux ; but
though its powers are undeniable, it will be
found frequently to fail*. I have alfo ufed,
with advantage, a tincture of gentian and
cinnamon in Port wine. Something aromatic

has

* Since coming to England I have been informed by
Dr. Garden, a learned and ingenious practitioner from
South Carolina, that this medicine, in order to produce
its proper effect, fhould be given in a very weak decoc-
tion;

CHAP. XI. "K F L XJ X E S. 453

has a good effed when added to the bitter,
being adapted to prevent or obviate flatulence,
which is a common and troublefbme fymp-
torn in this complaint.

That clafs of remedies which may be cal-
led pure astringents, might feem at firft fight
well calculated for cafes of this kind ; of
this fort are the terra Japonic a and ext radium
campechenfe ; but there *u?e few cafes in
which they are found by experience to be of
material fervice. They produce, indeed, a
temporary conitriction? but do not a£t fo ef-
fectually as the bitters on that habitual and
constitutional weaknefs wnich conftitutes
the difeafe.

The abforbent earths are a more ufeful re-
medy in this form of the difeafe. They
have, perhaps, a reftringent effect indepen-
dent of their power of abforbing acid. It

tion ; for that after having almoft abandoned it in confe-
quenceof its failure when he gave it hi irrong decoctions
and in fubftance, he was again convinced of ics efficacy
by ufing it in a very weak decoction, a lcj uple only being
boiled in a quart of water.

G8 3 is

454 • OBSERVATIONS PART III.

is certain, however, that great part of their
ufe coniifts in the deftru&ion of acid, which
is very apt to be generated in that depraved
ftate of digeflion which takes place in ad-
vanced fluxes, particularly in this lienteric
ftate of the bowels. In the early and acute
ftate the vegetable purgatives, fucn as cream
of tartar, tamarinds, and manna, are proper;
but in this advanced ftage they are hurtful
by the acidity and flatulence which they pro-
duce, and both the food and medicines
fhould be fo calculated as to avert and correct
thofe inconveniences. There is fomething in
vegetable acids extremely unfriendly to a
weak ftate of the bowels in general, tending
to bring on fpafmodic gripings and prevent-
ing a healthy digeftion and affimilation, as
we know in the cafe of heartburn, and of
thofe who make ufe of vinegar to check cor-
pulency, by preventing the formation of
blood.

Lime water has been recommended in old
fluxes, and I tried it in feveral cafes ; but,
except in one, I could not perceive any be-
nefit from it.

Abforbents

<*KAP. II. G N F L U X E S. 455

Abforbents may very pi e. ' ye c:m*

bined in prefcription with fome of the com-
pound officinal opia: a medicine v
thereby be formed, which will have at e:;:e
the advantage of an anodyne, a bitter, an
aftringent, a carminative, and abiorbent.
As thefe earths have little .or no taire, thev
may alio be added, with propriety, to the
common drink, as in the form of the chalk
julep, or decGCfum album. It may be thought
that here and eifewhere I have not been to
particular as I ought to be concerning the
forms, doles, and properties of medicines ;
but circumftances, iuc- as age, confritution,
and fymptoms, make thefe in a great mea-
fure difcretionary, and any one who is lurri-
ciently converlant with phi .: to be entrufted
with the charge of the lick, will have judge-
ment enough to vary his practice accordingly.
It has, therefore, been my object rather to
give the general principles of treatment than
the particular forms of medicines.

A proper regulation of diet as well as me-
dicine is of the utmoft conlequence in this

difeaie. A free indul of animal 'food

Gg 4 is

4$6 OBSERVATION* PART III.

is pernicious, particularly in the firft ftage
of it. ''In the chronic ftate a moderate ufe
of it is allowable, and in the lienteric ftate
it anfwers better in a folid form than that of
broth, which is apt to gripe and to run
quickly through the bowels. The beft ge-
neral articles of. diet are farinaceous bodies,
and thefe are greatly improved by being
toaftcd brown before they are ufed. It was
obfe; red in a former part of this work, that
the flux was fuppofed to have been prevent-
ed in the fleet commanded by Sir Charles
Saunders, by throwing burnt bifcuit into
the water ufed by the crews of the fhips.
It is a good practice to put a well-burnt
toaft in re all that the patient drinks, and
toafted bread, or panada made of toalted
bread or bifcuit, is one of the bell: articles
of diet. Brackifh water ought to be avoid-
ed, as it ruffles the bowels when in fo deli-
cate a ftate. Fermented liquors are impro-
per, except when the difeafe is advanced, and
where weaknefs and relaxation are the pre-
vailing fymptoms. Malt liquor will hardly
ever agree, on account of its acidity and fla-
tulence. Of wines, Port is to be preferred

CHAP. II. ON FLUXES. 4$J

as the mofl: ftrengthening, Madeira as the
leaft fubject to acidity ; and, for tft$ com-
mon men, no drink of tht fermented kind
is iafer than fpirits and water with great mo-
deration.

Warm clothing is of the utmofl confe-
quence in this difeaie, and external warmth
of the abdomen tends greatly to footh the
bowels. I have feen good effects from a
warm gum plaiter conftantly worn on that
part. Though cold is in general hurtful
and unfafe, I have neverthelefs known the
failors, who by their habits of life are com-
monly heedlefs, bathe in the fea when la-
bouring under what they call the white flux,
without any bad effects.

It fometimes happens that this difeafe
baffles every effort both of medicine and
diet, fo that a change of climate becomes
the only refource.

The lart caufe of habitual flux that was
mentioned was the retention of fcybala,
which keep up the irritation and tenefmus.
It is very natural to neglect purgative medi-
cines

45<> OBSERVATIONS JAB.T III.

cines when there feems already to be too
great "a difcharge by the bowels ; but there
is this inconvenience from omitting them
for a length of time, that thoi hard lumps
of feces, called y<^<W<2, are apt to colled in
the caecum and cells of the colon, as I have
{ten upon infpedting the dead bodies ; aid
the fibres of the inteifines being weakened,
their natural ftrength is not fuificient to ex-
pel them without being ftirnulated by a pur-
gative. It is therefore neceffary to give fome
evacuant medicine from time to time, even
though there mould be no griping nor any
marks of acrimony in the interlines. Rhu-
barb is allowed to be one of the belt medi-
cines for this purpofe; and I have alfo
known a combination of falts and fena have
z good effect after a long neglect of purga-
tive medicines. It is probable,-from the du-
rable effects produced, that thefe do not ope-
rate merely by the expulfion of fcybala ;
and we can conceive that they may be of
fervice by the removal of certain depraved
fluid fecretions, or that they may ftimulate
the vefTels to a more healthy action and a
more natural fecretion. Be this as it will,

experience

CHAP. II, ON FLUXES. 4$t)

experience teaches that in all fluxes it is of
advantage to interpofe from time to time
fome purgative medicine.

From the preceding view of the variety of
caufes which tend to keep up this difeafe, it
will appear that great judgement and difcri-
mination are neceffary in varying the prac-
tice according to circumitances ; and there is
no difeafe in which there is room for more
attention and nicety in adapting the different
remedies to the different fymptoms. We can
hereby alfo account for the various characters
that different remedies have had, fome having
been extolled by one practitioner while they
have been pronounced infigmficant by an-
other ; for no one remedy will fuit all the
various cafes of this diieafe. As it is of the
greateft consequence to diftinguifh thefe cafes,
I have been more particular and dirfufe on
this article than any other ; and having la-
boured under this complaint myfelf, I was
naturally led to take a greater intereft in its
treatment, and had alfo thereby a better op-
portunity of making obfervations on it.

CHAR

CHAP. III.

Of the StURVY.

1 SHALL not be fo minute either in the
defcription or treatment of the fcurvy, as of
the preceding difeafes. A detail of this kind
would lead to unneceflary prolixity and re-
petition ; for the prevention and cure of
it, confining in diet rather than medicine,
have been fully handled in the former parts
of this work; and the fubje£t, in the de-
fcnptive as well as the practical part, has
in a manner been exhaufted by Dr. Lind.
With regard to the theoretical part, I refer
the reader to the ingenious treatife lately
published by Dr. Milman.

It has appeared that the principal fource of
fcurvy is a vitiated or fcanty diet, and
that it is very much promoted by cold,
moifture, filth, {loth, and dejection of mind.
Hard labour has been affigned by fome as a
caufe ; but this is not conformable to my

obfervation

CHAP;in» ON THE SCURVY, 461

obfervation in general, and what has been
related to have happened in the * Conqueror,
more particularly led me to be of a contrary
opinion.

The principal differences of the fymptoms
of the fcurvy in hot and cold climates, fo far
as I have obferved, are, that in the former
the livid hardnefs on the extremities is an ear-
lier fymptom, and in the latter the gums
are iooner affected, and the difficulty of
breathing is a more frequent and more un-
eafy fymptom.

' There is a remarkable fymptom fometimes
attendant on this difeafe which has efcaped
authors, and is mentioned in Mr. Telford's
Report, page 22. This is the nySialop'm^
or weaknefs of the eye-fight f, which was
alfo common in the garrifon of Gibraltar,
among thofe who were affected with the
fcurvy, a difeafe that prevailed much during
the late fiege of that place.

* See page 322.

\ I was informed of this fact by Mr. Cairncrofs, an
ingenious furgeon belonging to one of the battalions that

feiyed there during the fiege.

With

4^2 OBSERVATIONS PART III.

With regard to the cure, enough has been
faid in the preceding parts of this work to
prove that frefh vegetables are the mofr.
effectual antifcorbutics. I fhall here mention
a fact farther in proof of this, which has not
before been taken notice of. When the
fleet arrived at Barbadoes in May, 1 781,
part of the foldiers who ferved as marines
were affected with the fcurvy, and being fent
to the army hofpital, where at that time no
frefh animal food was allowed, they reco-
vered much falter by being confined to ve-
getable articles, than the feamen who were
fed upon frefh animal food without any frefh
vegetables.

It has farther appeared, that there is fome-
thing in a particular clafs of fruit of the lemon
and orange kind, which far furpafles every
other remedy, whether dietetic or medicinal.
Numberlefs instances have occurred in the
preceding part of this work, of men having
recovered at fea from ufing the juice of this
fruit alone, even under all the inconveniences
of a fea diet. When the juice is intended to
be kept for a length of time, it mould be

exprefled

CHAP. Ill, ON THE SCURVY* 463

expreffed and bottled, a fmall quantity of
fpirits being added to preferve it; for if fire
is ufed in preparing it, as in the form of a rob,
I know for certain that its virtues are very
much impaired. It is very difficult to fay
upon what principle thefe fruits act, for no
fenfible effects are produced by them except
a fmall increafe of fome of the fecretions.

It ought to be mentioned here, as a fact of
great confequence, though very little known,
and never, I believe, publimed before, that
the juice of limes and lemons is the befl de-
tergent of any external application that has
yet been tried in fcorbutic ulcers. Nothing
was found fo effectual in preventing thefe
from fp reading, and vin difpofing them to
heal, as an emollient poultice with lemon or
lime juice fprinkled on its furface. Or it
was applied by foaking in it the lint with
which the fore was drefled, and alfo as a
lotion, in which cafe it was ufed diluted
with two or three times its quantity of wa-
ter ; for if ufed pure, it was found too irri-
tating, and was apt to bring on a fungous
difpofition. Mr. Lucas, furgeon of the Con-
queror,

queror, favoured me with feveral valuable
remarks in proof of this pradlice. A poul-
tice was always found a good application in
thefe cafes, by its power of abforbing the
acrimonious difcharge, which would other-
wife irritate the fore itfelf and the neigh-
bouring parts.

The fleet was furnifhed with effence of
malt, but its powers were fo inconfiderable
that fome of the furgeons denied that it had
any. In trials, however, that were made in
an early flate of the difeafe, it was found to
have a fenfible effect in checking and re-
moving it. It was alfo found of evident ufe
in the bad ulcers fo apt to arife in fcorbutic
habits, and in this intention was fuperior
to the Peruvian bark as an internal alterative.
Indeed, in thofe ulcers that were truly fcor-
butic, the bark was found to be of very little
ufe ; and next to what has been already
mentioned, joined to the advantages of diet,
opium was found of the greatefl fervice
in difpoiing thefe as well as all other ill-con-
ditioned fores of hot climates to heal.

I have

CHAP Hi. @N THS SCURVY. 4.6$

I have mentioned the fcorbutic habit as
diftinguifhedfrom the fcurvy, but there feems
to be no difference but in degree ; for a perfon
may be laid to labour under the difeale before
it betrays itfelf by any obvious fymp-
torn, and it mufh have gathered a certain
degree of force before vifible fymptoms are
produced. The chief mark of this latent and
incipient ftage of the difeafe is that incurable
{late of ulcers that has been mentioned,
whethertheyappearfpontaneoufly or in confe-
rence of flight accidents. There is another
mark of this fcorbutic habit which is not
mentioned in any defcription of the difeafe
I have ever fccn. It is a foft indolent tu*
mour which arifes under the fkin on a part
which has received a frnall blow, or contu-
fion, fo flight as not to break the fkin.
It mofr. commonly appears about the el-
bow or fore-arm, and generally difappears
without any inconvenience, what it con-
tains being ablorbed. A furgeon who opened
one of them, (a practice, however, not to
be approved of) informed me that if coniifted
of fluid blood. We may alfo reckon a languor,
or fenfe of weight, as one of thole marks of

H h fcurvy

OBSERVATIONS *ARf UU-

fcurvy which occur before the more obvious
iymptoms appear.

In this ftate of the difeafe, the articles of
lefTer powers, fuch as malt and melaffes,
may be of fervice by preventing its farther
progrefs, or the appearance of a£tual fymp-
toms, and by reftoring the con flit ution«

In lome of the early ftages of this difeafe
the efrervefcing mixture of acids with fixed
alkali may probably alfo be of ufe : 1 never
could perceive any fenfible benefit in thofe
cafes in which I tried it, though fome of the
gentlemen of the fleet reported to me that-
they thougiit it of fervice.

There is no article of the Materia Medica
yet known that pofTeffes any confiderable
power over this difeafe without the affiftance.
of proper diet. With this afliftance, how-
ever, it is found, that whatever tends to
increafe the fluid fecretions, haftens very
much the recovery of the fcorbutic patient.
I have obferved a very finking inflance
of this in the effects of a fpontaneous diar-
rhoea ;

CHA?. Ill* ON THE SCURVY. 467

rhoea; for I have feen thofe hard livid
fwellings on the legs that form one of
the moil, conftant fymptoms of this dif-
eafe almoft difappear, and the hams, from
being contracted, become flexible in the
courfe of twelve hours upon this coming on.
I have endeavoured to imitate this with pur-
gatives, but never with the fame effects as
the natural loofenefs. A free flow of urine is
alfo found to promote the recovery, and vine-
gar of fquills is one of the moil effectual me-
dicines in this intention. It is likewife of
Angular fervice to excite fweat ; for an ob-
struction of perforation feems to be one of
the principal constituents of the difeafe. The
goofe (kin, which is an early and conftant
l'y mptom of this difeafe, feems to be owing
to a constriction of the exhaling veflels*
Dover's powder has been employed with
advantage as a fudorific,. with decoction
of the woods drank warm, and plentiful
warm dilution. Camphor combined with
nitre has been found one of the beft re-
medics, and it acts both as a diaphoretic and
diuretic.

H h 2 Every

OBSERVATION'S *ART Ilfr

Every thing which relaxes the fkin by ex-
ternal application alfo forwards the cure,.
The contraction of the hams and the livid
hardnefs of the calves of the legs are re-
lieved by emollient cataplafms. Burying the
legs in the earth, which has a fenfible good
effect, feems to act on the fame principle,
for it makes the parts fweat profufely.

There can be no doubt that in the fcurvy
there is a flagnation of the humours in the
fmall veffels, particularly of the lower ex-
tremities, and that it is to this circumftance
that the livid hardnefs of the flemy parts of
the legs is owing. The effect of medicine in
removing this, mull be to reftore the action
of thofe torpid vefiels, fo as to bring the
itagna'ted 11 aids again into circulation. Pur-
gatives feem to act upon it as they do in the
dropfy, by exciting abfbrption. The irritation
of the bowels and their increafed fecretion thus
affecting the minute veffels in all parts of
the body, is the refult of that fympathy or
balance eitablifhed between every part of the
fyftera, in order to fupport the harmony and
effect the purpofes of the animal ceconomy.

€HAP. XIX, OK THE SCURvT, 469

It has long appeared to me, that the fcurvy
is owing rather to a defect of nourifhment
than to a vitiated ftate of it. In fa&, that
fort of food which is fuppofed mofl com-
monly to induce the fcurvy, is in moft, cafes
not putrid, but is in an unnatural and de-
praved if ate by being drained of its juices,
which run off in brine ; and perhaps fome of
the more fubtile and nutritious parts are wafted
by evaporation. It is not found that fait of
jtfelf has any effect in inducing the fcurvy,
and indeed it can be induced under a ftate of
diet in which there is no fait, as we know
from fome inftances quoted by Dr. Lind 5
and fome cafes are related by Dr. Monro and
Dr. Milman, in the Medical Tranfa&ions,
which are in proof of the fame opinion : but
the cafe moil in point to prove that it de-
pends on a defect of aliment, is that of Dr»
Stark, who, by way of experiment on b'm-
felf, reduced his diet to the leafl quantity he
could fubfrfr. upon, and was thereupon af-
fected with the fymptoms of the fea fcurvy.
I have alfo known fome fymptoms of it arife
in old people in confequence of Jong abfti-
nence, owing to the want of appetite.

HI13 It

470 v OBSERVATION* *AfcT III}

It would appear that the aliment we take
in, afts in two ways in increafing the vi-
gour of the body. Firft, by affimilation,
Whereby it affords the matter of which the
folids of the body are made in order to carry
on growth in youth, and to repair the wafte
of parts in adult age. A very fmall quantity
of matter is neceffary for thefe purpofes ;
and as a proof of it, we fee people fupported
equally well with very different quantities
and qualities of food. Secondly, Food is
neceffary as a flimulus, either by a power it
has of foothing the nerves of the ftomach,
and the other furfaces to which it is applied,
or by its volume in diftending the inteftines
and blood veffels. It is upon this principle
that luxury renders the great quantities of
food we take in neceffary, and thofe fpe-
cies of food which fatisfy moft by their
flimulus are by no means fuch as are the
moft nutritious. It is alfo upon this princi-
ple, that in cafes of accidental hardfhip from
want of food, or in barren and inclement
countries where food is fcarce, the body is
fupported, in fome meafure, by what con-
tains little or no nutritious matter, fuch as
i|t pure

CHAP. III. ON THE SCURVY, 47 1

pure water, or the bark of trees powdered
and kneaded into a fort of bread, as we are
told of the inhabitants of Lapland,

There are other familiar and well-efta-
bliflied fa£ts which prove, that either from,
the influence of difeafe, from habits of life,
or the nature of particular animals, life can
go on for a length of time with little or no
aliment. This is the cafe in fevers, in fea-
iicknefs, in certain lingular cafes that have
been recorded*, in torpid animals, and in
animals of cold blood. Though a man will
die for want of food in a very few days, it
does not follow that this is owing to the want
of matter to repair the wafte of the body.
The craving for food, and thefaintnefs from
long abstinence, arife from the want of the
accuftamed ftimulus, efpecially in thofe who
^are ufed to live well ; and a perfon feels him-
felf moil refrefhed by food and drink when
newly taken in, and before it can be applied
to the purpofe of nutrition.

* See the Medical EiTays of Edinburgh. Sennertus,
lib. iil, part i. feci. ii. — Haller Elem. Phyfxolog. lib. xix.

fett.ii.

Hh 4 As

47a o b s £ */v a-'-* i o » f part m«

As there is a continual wafte and decaya
however, both of our fluids and folids, fame
degree of reparation is abiblutely neceflary,
efpecially to animals of warm blood; and
fuch ingejla as would give the ftimulus of
food, without being pofleffed of any nutri-
tious principle, would indeed continue life
for a certain time ; but difeafe would enfue.
The proviiion ufed at fea anfwers, in a great
meafure, to this defcription ; for unlefs the
powers of digeftion and affimilation are re-
markably ftrong, fait beef and bifcuit, which
have been long kept, do not contain much
more nouriihment than faw-duft, or the bark
of a tree, and the difeafe induced by this diet
is the fcurvy.

The nature and lymptoms 6f the fcurvy
countenance this opinion : for as the means
of renewing the animal matter of our bodies
is withdrawn under this courfe of diet, na-
ture, in confequence of an accommodating
principle, obferves a fort of frugality, and the
animal ceconomy adopts fuch meafures as may
be productive of the leaft poffible wade and
corruption of the fluids. All the fecretions are

accordingly

CHAP., lit. OK fHB SCU&YY* 473

accordingly fcanty ; and, in particular, one
of the firft fymptoms of it is a fuppreffion of
perfpiration, as appears by the goofe-ikin
that attends this difeafe. There is a paucity
of urine. There is alio a great languor in
the circulation, which may be confidered
either as a means adopted by nature to pre-
vent that vitiated and effete ftate of the
fluids which a brifker action might induce ;
or it may happen for want of that due fup-
ply of nourimment neceflary to produce a
vigorous action of ail the functions.

We have a proof of this general languor
not only from the great averfion to motion,
and the great difpofltion to fyncope, but
from the inflection of the dead body, from
which it appears that the whole circulating
fyftem, being more flaccid and elaftic, is
fubject to preternatural diflention. The
heart is accordingly found enlarged in bulk,
the flze of the cavities being increafed ; and
in the extremities, where the circulation is
naturally mod languid, the fmall veflels
carrying the colourlefs part of the blood, are
fo far enlarged as to admit the red part of it,

474 OBSERVATIONS PART HI.

as appears by the livid colour ; and where
this is the cafe, thefe veffels are unable to
carry on the circulation at all, and a ftagna-
tion takes place, as is evident in" thofe livid
appearances moil: common about the calves
of the leg, which feel hard like a cake. I
have examined thofe parts in the dead fub-
jecl:, and found a want of fluidity in the con-
tents of the veffels, but could not difcover
any thing like ecchymofis ; from which I con-
cluded that the colour was owing to an error
loa, and the hardnefs to ftagnation and
coagulation of the fluids, and a want of ac-
tion of the veffels.

The incurable ffate of ulcers, fo common
in this difeafe, is alfo what we might expect
from the defe£t of frefh affimilated juices ; for
where a breach is made, either by nature or
accident, in the folids, particularly of the
extremities, the proper iuppuration is pre-
vented by the depraved ftate both of the
fluids and veffels ; and we cannot expe£t that
renewal of folid parts in which healing con-
fills, where both the inftruments and mate-
rials of its formation are fo defective.

I mall

CHAP. III. ON THI SCURVY. 475

I (hall conclude what I have to fay on this
fubject, by fhortly confidering whether or
not this difeafe is ever contagious.

There is fomething in the nature and
hiilory of the fcurvy that would lead us at
once to pronounce that it is not infectious ;
for the external caufes on which it depends
are fo obvious, and feem fo adequate to ac-
count for its appearance and prevalence upon
certain occasions, as atfirfl fight to exclude
every other caufe.

But it feems extremely unphilofophical to
deny the reality or poffibiiity of any thing in
Nature, from our fuppofed knowledge of the
means and caufes me employs, particularly
in a branch of fcience fo obfcure as the ani-
mal ceconomy. Could we, therefore, prove
the point as a matter of fact, it would be in
vain to deny it, from our fancied acquaint-
ance with Nature's modes of operation.

The fads which give a fufpicion of the
fcurvy being infectious, are, lit, What is
related by Dr. Lind, that the fea fcurvy

fpread

476 OBSERVATIONS PART HI,

ipread at one time from the naval hofpital to
the people of the adjacent country. 2dly,
There occurred feveral inflances in the firfl
part of this work, of this difeafe prevailing
to a much greater degree in fome * particu-
lar fhips than others, though upon the moft
accurate inquiry there was found no diffe-
rence in the diet, or any other external or
predifpoling caufe adequate to account for
this. We can conceive, that thofe fhips
having accidentally a few men, whofe con-
ftitutions were remarkably predifpofed to
this difeafe, might catch it earlier than in
other fhips, and communicate it to the reft
of the crew.

The only practical inference that would lie
from the eftablifhment of this fact would be,
that when the difeafe begins firfr. to appear,
the men affected mould be feparated from the
reft ; and this is a good practice, whether
this opinion is true or not ; for fuch men
ought to be put in one mefs, in order that

* In the PrincefTa, 178 1, and the Nonfuch, Prince '
Geerge, ami Royal Oak, in 17821.

they

they may live upon the fame autifcorbutic
articles of diet, and that they may be hin-
dered from the ufe of their common provi-
sions, of which this difeafe does not maks
them lofe the relilh*

CH A P.

47S eij'MVATIOMl PART III.

CHAP. IV.

Of the Wounds received in the Aftions of
April, 1782.

Lofs in the Battle and from Wounds — Fatality of the
locked Jaw — Treatment of it — Some Ships more fub-
je6l to it than others — Different from other Cafes of
Tetanus — It is not cured by the Removal of the Part —
It may come on afier the Part is cured— Effect of Cli-
mate in producing it — Accidents from the Wind of a
Ball— Accidents from the Exploflon of Gunpowder-
Means of preventing them— General Obfervations on
Sores and Wounds,

JL HOUGH furgery was not properly in
my department, yet, having had a fair
opportunity of collecting fa£ts concerning
this branch of practice, I thought it my
duty to pay fome attention to it.

The whole number of men wounded in
the actions of April, 1782, amounted to 81 a.

CHAP. IV. Q N W O W N ~D S. 47^

Of thefe, fixty died on board before the
end of the month, five in the courfe of the
following month, and two in June.

There were ninety-feven wounded men
fent to the hofpital at Port Royal, of whom
there had died twenty-one when the fleet left
Jamaica on the 1 7th of July.

So that the whole lofs of men in the bat-
tles of April, and their conferences, is as
follows ;

Killed outright - - - 266

Died of their wounds en board - 67
Died of their wounds at the hofpital 21

Total

354

Of tbofe who died on board, fifteen* were
carried off with the fymptoms of the locked

jaw;

* Since this was firft written, the melancholy tidings
hav arrived cf another cafe to be added to this fatal lift.
It is that of rhe amiable and gallant Lord Robert Man-
ners, who commanded the Refolution on the 12th of
April, and having loft bis leg, befides receiving a wound

ia.

4$0 eBSERVATlONi FART III.

jaw ; but of thofe fent to the hofpital, only
one. The reafon that fo few in proportion
were affected with it in the hofpital may
have been, that none of the wounded were
landed till near the end of the third week af-
ter the principal action. The danger of this
fyrnptom was then, in a great meafure, pair,
though I have known it to take place in every
period from the fecond or third day till the
fourth week.

Only three men in the whole fleet reco-
vered from this alarming complaint ; and as
it is interefting to know every thing relating
to fo defperate a iymptom, I fhall give a Ihort;
account of each.

The firft was a feaman of the Montagu,
who had his thigh wounded by a fplinter

in his arm and breaft, died of this untraceable fymptom
on hispafTage to England; and though he fhared a fate to
be envied by every lover of true glory, his lofs can never
be enough deplored by his country and friends, being
formed by his great virtues and accomplilhments, joined
to the luftre of his rank, to hold out an example of all
that was good and great as a man and an officer. Nor is
his lofs to be regretted more by any one than myiclf,
having been honoured with his friendship and patronage.

which

pUAP. IV. ON WOUNDS. 4$i

which carried away part of the integuments
and membrana adtpofa^ and lacerated in a fniall
degree the vqflus externus mufcle. The
wound did extremely well till the 23d day,
when the jaw became almoft entirely fixed,
and the whole mufcles of the wounded fide
were thrown into frequent fpafms. Mr.
Young, the furgeon, who was always anxious
and afliduous in his duty, confulted with me,
and we had immediate recourfe to the warm
bath, which gave a degree of inflantaneous re-
lief, and was repeated twice a-day for half an
hour. He was fenfibly better every time; in
nine days was entirely free of the fymptom,
and continued afterwards to do well. The
only other means taken for this man's reco-
very, betides what were ufedwich the other
wounded men, wrre from three to five grains
of opium, which he took every day.

The next was a feaman of thirty years of
age, belonging to the Magnificent, who had
the humerus broken and mattered by a fplin-
ter which entered the deltoid mufcle. Se-
veral large portions of bone were extracted,
and the artery was laid bare on the infide.

I i On

4r%% 6I*BRVATIGMS part in,

On the fifth day there came on a large icho-
rous difcharge, with a low quick pulfe and
depreffed fpirits, and the jaws began to ciofe,
with pain and itric"ture on both fides about
the articulation of the lower jaw. He had
every day fince the accident taken half an
ounce of Peruvianbark, combined with opium
or rhubarb, according as it made him loofe
or cofKve. This was continued, and the part
externally was kept conftantly moifl all'
round with volatile liniment, to which a
fourth part of tinffinra thebaka was added.
Next day, the jaw was almoft entirely
fixed, fo that it was with difficulty that a
little wine and water could be introduced
with a fpoon. Mr. Harris, the furgeon,
now wifely determining to do fomething.
vigorous in this unpromifing fituationr beat
Vip twelve ounces of opium moiftened ta
the confidence of a cataplafm with the
thebaic tincture, and applied one half tc*
each fide of the jaw. The patient this day
fwallowed a pint of the bark decoction with
half an ounce of nitre, and took a diapho-
retic draught of twenty drops of thebaic
tincture a^d thirty of antimonial wine. He

bad

CHAP.IT. on wounds.

had alfo the fmoke of tobacco thrown up his
noftrils.

On the third day after the attack he could
open his mouth half an inch. The cata-
piafms were taken off, beat up afrefh with
the tincture, and applied anew. The bark
and other medicines were continued. On
the fourth day the ltrichire and pain of the
jaw entirely went off, but the cataplafm and
volatile liniment were applied for three days
longer. The wound produced a laudable
discharge, every fy mptom became favourable,
and he continued to recover.

The only other perfon who recovered from
this fymptom was a man in the Bedford.
Several died of it on board of this mip ; and
as the fame means of relief were fkilfully
employed in all the cafes by Mr. Wickes,
the furgeon, the fuccefs feemed owing more
to fomething favourable in the man's con-
ftitution, than any thing peculiar in the
treatment, which confifted in the adminiftra-
tion of the warm bath, opium and camphor,
with mercurial friction on the jaw.

Ii % This

4$4 OBSERVATIONS tART ttU

This accident affected fome mips remarka-
bly more than others, particularly the Bar-
fieur and Bedford, though their wounds had
nothing peculiar, nor were in a greater pro-
portion than in the reft of the fleet. Four
were carried off by it in each of thefe mips.
It has formerly been obferved, that great
fhips acquire peculiar habits, or difpofitions,
which incline the confcitutions of the men to
one difeafe more than another. This com-
plaint took a run in fome particular mips lad
year alfo after the battle of the Chefapeak ;
and 1 have known it prevail in fome particular
hofpitals more than others. In the prefent
inftance, it may have been owing either to
fomething peculiar in the confHtution, or air
of the mips ; or we can conceive it to be
owing to fome fort of nervous fympathy,
jufl as the epilepfy* has been known to fpread
from one boy to another, at a fchool, in con-
sequence of irritation, dread, horror, or fome
fu'ch delicate nervous or mental affection.
We have in yawning an example of a fpaf-

* See Kaau Boerhaave's account of this epiieply In a
fchool at Harlaem.

modic

CHAP. IV. ON WOUNDS. 485

modie affection fpreading from one perfon to
another. If this is the cafe in the locked
jaw, thofe affected by it mould be removed
from the prefence of the other wounded men,
left the idea of the fufferings of others mould
be fo fixed in their mind, or fo imprefs them
with the fear of the like, as to invite the at-
tack of the fame complaint.

Though the locked jaw in confequence of
wounds refembles frequently in itsiymptoms
the tetanus which arifes without any external
2' Cidcnt, yet there are many cafes of the
mer ivhich difTLr materially from the vio-
|t fymptoms of the other, as described by
Lj moil cafes of the locked jaw
M wounds the fpafms arc not fo general,
violent, nor attended witji luch exquilite
pain. It fometirnes happens that trie con-
vulfive twitchings are even accompanied with
a fort of pleafure, as in the cafe of a lieute-
nant of the Montaru, whole cafe was re-?
lated to me by Mr. Young, the furgeon, a
man of fkill and oblervation in his prorefTion,
aud upon whole fidelity and accuracy I could
perfectly rely. This officer had been wound-

t ,

I 1 3 ed

OBSERVATIONS f ART III.

ed in the elbow at the battle of St. Chrifto-
pher's, by a fplinter, whereby the capfular
ligament of the joint was injured. On the
ninth day, fymptoms of the locked jaw
came on, and foon after the whole mufcles
of the wounded fide were affe&ed with fre-
quent convuliive twitchings, which, as he
faid himfelf, afforded a pieafant ienfation,
exciting laughing like an agreeable titilla-
tion. He died on the fourth day after it
came on, and had no pain to the lafL

The locked jaw from accident differs alfo
from other cafes of tetanus, in refpecl: to its
cure ; for the latter has been fuccefsfully
treated by cold bathing, as is related by
Dr. Wright * and Dr. Cochrane f ; but it is
acknowledged by them that this^treatment
did not anfwer in the former.

It Is to be remarked, that the locked jaw
did not take place in tHofe cafes in which the
wounds had a foul and gangrenous appear-

* London Medical Obfervations and Inquiries, vol. vi.
•f Medical Commentaries, and a Thefis printed at
Edinburgh, 1784.

ance

jchap. it. o-ir wounds. 4S7

ance more than others; for thofe that di*
geited and cicatrized favourably, were equally
apt to be affefted by it ; and though amputa-
tions are moft liable to this fy mptom, the
flighted injuries, even a ferateh, will fome-
times bring it om

In the Bedford there occurred a curious
circumflance concerning this complaint. In
one of the cafes that proved fatal, the fymp-
torn did not come on till the wound was fe
far healed that all dreffing had been laid
a fide.

Mr. Wood, furgeon of the hofpital at Ja-
maica, informed me, that in cafes of the
locked jaw from injuries to fmall members,
fuch as fingers, he had tried the effe£t of
amputating the part after the fymptoms had
come on, but without any effect in putting a
flop to them.

Would it not appear, from the two laft-

mentioned fads, that this fymptom is not

kept up by an immediate prefent irritation,

but that the conftitution comes to be fo mo*

J i 4 dified,

4^8 OBSERVATIONS PART III,

difed, or receives fuch an impulle, as it
were, that the complaint runs is courfe
without any continued Jtimuius to keep it up ?

It would be difficult to affign a fatisfactory
reafon why this accident is more frequent in
hot than in cold climates. The effect of
external heat upon the living body is not to
raife its temperature even when the heat of
the air exceeds that of the body ; and we are,
therefore, to feek for the effects of it in fome
of thofe affections peculiar to animal life.
And as the outward temperature of the air
does not affect the general mafs of the body,
all the effects produced by it muit depend on
jmpreffions made on the external furface of
the body and lungs ; and the fkin, which
may be confidered as a large expanded tiflue
of nervous fibres endowed with univerfal
lympathy and great fenfibility, affects every
organ and every function of the body, ac-
cording to the If ate of the air in contact with
it, whether cold or hot, moift or dry,
pure or vitiated. This fympathetic feniibi-
lity of the fkin is chiefly affected by the
(late of the perfpiring pores on its fur-
face ;

CHAP. IV. O. W . W O U N D So 489

face ; for it is only when thefe are open, that
the imprefiion of the air on the fkin pro-
duces catarrhs, rheumatifms, and internal
inflammations in cold climates ; and the ex-
ternal temperature in hot climates being fucli
as to keep the pores almoil: always open,
this feems to be a principal reafon of that
univerfil irritability prevailing there, and
of the general fympathy that prevails between
every part, particularly as connected with
the organs of perfpiration*. This read!-
nefs of one part to be affected by another
in hot climates is well illustrated by the
Hidden tranflation of certain difeafes. I have
feen, for inflance, a catarrh ceafe and be
converted, as it were, into a diarrhoea, and
this as quickly difappearing, a pain in the
foot would arife, like an attack of the gout.
All this would happen in the fpace of a
few hours.

* That fpecies of locked jaw, called by authors the
Trifmus Infantium, to which children are liable the firft
week after birth, is probably owing to the contact of
the external air upon the fkin which is accuflonied in
the womb to a moift and warm medium.

But

49° OBSERVATIONS PAJIT III.

But in coLi climates, wounds are by no
means exempt from the locked jaw ; for it
fometimes occurs in England, where I have
fmn it even in the winter feafon*.

Since my return to England I have re-
ceived fome new and ufeful information on
this fubjett in converting with Dr. Warren,
prryficiaii to the King ; and as any obferva-
frions derived from fo much acknowledged
Ikill and fagacity mufr. be valuable, I (hall
here relate what he was fo kind as to
communicate to me.

This eminent phyfician in attending a
cafe in which he, was nearly interefted,
and in which his endeavours were rewarded
with fuccefs, found the greateft benefit from
opium and the warm bath. The opium was
given in the form of tincture, in moderate
but pretty frequent dofes. The bath was
compofed of milk and water, and the ad^
dition of milk was, no doubt, an im^

* Aretaeus Cappadox fays, that tetanus in general is
even more apt to occur in winter than in fummer. De
Cauf. & Sign. Morb. Acut. lib. i, cap. vi.

provement j

CHAP. IV. ON W O V N D 8. 49J

provement ; for there is fomethlng .in this
as well as oil extremely foothing to the
human nerves. Dr. Warren ha*d intended to
make trial of a bath of oil in cafe this had
failed. He mentioned the following ©b-«
fervation, with regard to the external appli-
cation of oil, which could only have been
fuggefted by that anxious attention that was
paid to the cafe. It was found, that the un-
eafinefs arifing from the fpafm was allayed
by conftantly drawing a feather wetted with
oil over the temples, which had an evident
effect in lulling the pain and fpafm ; for
when this operation was left off, there was
an immediate recurrence of thefe fymptoms*.

It would appear, therefore, from this as
well as the former cafes, that opium and

* There are feveral valuable practical remarks on this
complaint in fome of the ancient authors, efpecially
Aretaeus Their principal means of cure conlifted in
the application of warm oil to the whole furface of
the body, particularly of the part affected. This au-
thor a io recommends clylters of Warm oil, with a pur-
gative called hlera (fuppofedto be an aloitic medicine) oc-
cafionally combined with the:n. Aretasus Cappad. De
Curat. Morb. Acut. cap. vi. Celfus, lib. iy. cap. iii.

the

492 OBSERVATIONS PART III.

the warm bath are the only remedies yet
known which are of fervice in this complaint,
and much will depend on the judicious ma-
nagement of them. The method of admi-
mftering the opium, recommended by Dr.
Warren, feems to be the moil judicious,
efpecially in conftitutions not habituated to
this medicine.

There is a certain medium in giving opium,
by which its beft. effects are obtained, for in
an under dofe it will produce difturbance in-
ilead of reft; and when it is given in large
quantities it frequently defeats the very end
for which it is given, by throwing the body
into convulfions which terminate in death.
The rule for judging of the proper limits of
this dofe, is by its effect in inducing that flupor
or infeniibility which renders the lenfes inca-
pable of irritation. Though a dofe greater
than ordinary is required to produce this ef-
fect in cafes of fpafm, and though the cui-
ftitution in that fituation will bear more, yet
even here it may be given to excefs ; and by
beginning with fmall quantities, and giving

CHAP. It. ON WOUND S", 493

it in frequent rather than large dofes, the
constitution will thereby be better recon-
ciled to it, and it will alio with more conve-
nience admit of that gradual increafe which
is peculiarly neceffary with this medicine.
Thefe ideas were fuggefled to me by Dr.
Warren ; and it may be farther added, in
recommendation of his method, that the
liquid form is preferable to the folid, as the
effects of it will fooner be feen, and a better
judgement can be formed how far it is pro-
per to pufh it.

Great attention is alfo necefTary iri regu-
lating the heat of the bath ; for if it is not
fufficiently warm, it will not have the effect
of producing a due relaxation ; and if it
mould be too hot, it will Simulate too
much, and will have the farther inconve-
nience of making the patient very faint
in a fhort time. It cannot be well regu-
lated without a thermometer, and 93° upon
Fahrenheit's fcale is perhaps the beft tem-
perature. I have kept a patient in a bath
of that heat for fix hours, which he could

not

494 OBSERVATIONS PART III.

not have endured for half an hour had the
heat been three or four degrees higher.

The circumftance next in confequence, in
the cure of this complaint, is the keeping
up a moifture on the fkin, and guarding the
furface of the body from the accefs of the
air. This is particularly neceffary with re-
gard to the part itfelf, which mould be con-
stantly enveloped in warm, anodyne, and
emollient applications. The good effe&s of
this is particularly exemplified in the cafe
which recovered under the care of Mr. Har-
ris, who gave the diaphoretic medicine,
compofed of antimonial wine and laudanum,
and applied the anodyne cataplafm to the
external fauces. It was remarked, that the
locked jaw was mofl incident to thofe
wounded men who lay in parts of the hofpi-
tal where they were expofed to a current of
air; and the cafes of tetanus that mofl
uiually occur in the Weft Indies, inde-
pendent of wounds, are thofe of (laves who
fall afleep in the night-time in the open
air.

There

CHAP. IT; O N W O U N D &• 4$5

i:There is a lingular fpecies of accident to
which engagements at fea are liable, the
wind of a ball, as it is called. If a can-
non-ball in its flight panes clofe to any part
of the body, it renders it livid and numb
for fome time. It is mod dangerous when
it approaches the ftomach ; and there was an
inftance of a man in the laft battle, who,
upon a bail paffing clofe to his ftomach,
dropped down dead inftantaneouily, without
the lead viiible marks of injury. Another,
in confequence of a ball palling clofe to his
belly, remained without fenfe or motion for
fome time, and a large livid tumor arofe on the
part, but he recovered. I attended a man at
the hofpital at Barbadoes, who had the but-
tons of his trovvfers carried off by a cannon-
ball without its having touched the body.
The pubis was livid and fweiled for fome time
after : he differed exquiilte pain from ilran-
gury, which feemed to proceed from a para*
lyjis of the bladder, for he voided no water
without a catheter for near three months, after
which time he recovered. I know a brave
young officer* in the army, who had his

* The honourable Captain Fitzroy.

epaulette

49& OBSERVATION' S PART III.

epaulette carried off by a cannon-ball at
Charleftown, in confequence of which the
ihoulder and adjacent parts of the neck were
affected for fome time. A like accident hap-
pened to a marine officer in one of the late
engagements ; but in neither of thefe was
the head materially affected, nor is it fo apt
to be affected in this way as the itomach. I
never knew death the confequence of the
wind of a ball on the head, though an offi-
cer* in the Sultan, at the battle of Grenada,
was fo ft mined by a fhot paffing near his tem-
ple, as to be infenfible for fome time, but
lie recovered entirely in a few hours -f. Thefe
facts accord with the doctrine advanced
by Mr. Hunter, that the ftomach is more
effential to life, and more immediately the
feat of it, than the head or any other organ or
member of the body.

The clafs of wounds moft peculiar to a fea
engagement are fcorches from the accidental

* Colonel Markham.

~Y Animals are affected by thefe accidents as well as
men. A cow in one of the fhips was killed in one of the
actions in April, by a double-headed fhot paffing clofe to
the fmall of her back.

expiation,

CHAP. IV. ON WOUNDS. 497

cxploiion of gunpowder ; and in moft of the
campaigns in which I have ferved they have
been very frequent and fatal. Few accidents,
however, of this kind happened in the late
engagements ; fo that we had but little ex-
perience of this fort of wounds in April 1 782.
But on former occafions they were very fre-
quent, and the beft application to the burnt
parts was found to be linfeed oil, which
fome of the furgeons mixed with lime-
water, others with ceruffe, and both com-
poiitions anfwered well. Opium was found
of great ufe in alleviating pain and procuring
reft, care being taken to guard again ft coftive-
nefs by the ufe of clyfters. In the battles of
1780 and 1 78 1, one fourth part of the whole
killed and wounded was from this fort of ac-
cident; but on the 9th and 12th of April
1782, only two accidental exploiions of gun-
powder happened in the whole fleet, by one
of which one life was loft, by the other, two.
This difference was owing partly to greater
experience and habits of caution acquired in
the courfe of the war, and partly to certain
improved methods in working the artillery
introduced by Sir Charles Douglas, which,

K k like

OlSIlUT IONS f ART Ilf.

like all his other valuable improvements, tend
to give facility and expedition, as well as to
fave the lives of men. The circumfiances
which tendto preventexplofions,are, ift, The
•wetting of the wads, which prevents their
inflaming and blowing back when they fight
the weather fide of the lTiip ; a circumftance,
which, without this precaution, gives oc-
cafion to a number of accidents by the burn-
ing parts catching the loofe powder, or fet-
ting fire to the cartridges. 2dly, The ufe
of goofe-quill tubes and imall priming boxes
made of tin, inftead of the large horns for-
merly in ufe, whereby great quantities of
powder were fcattered about and expoled to
accidental fire. 3^1y, The ufe of locks,
which was practifed with great fuccefs in
feveral mips, and was found to make the
operation both more fafe and more expe-
ditious.

It frequently happens that men bleed to
death before affiftance can be procured, or
iofe fo much blood as not to be able to go
through an operation. In order to prevent
this, it has been propofed, and on fomc

occafions

CHAP. IV. 0 N W O U N D S. 499

occafions practifed, to make each man carrj
about him a garter, or piece of rope-yarn, in
order to bind up a limb in cafe of profufe
bleeding. If it be objected, that this, from its
folemnity may be apt to intimidate common
men, officers at leafl mould make ufe of fome
precaution, efpecially as many of them, and
thofe of the highefl rank, are {rationed on
the quarter deck, which is one of the moft
expofed fituations, and far removed from the
cockpit, where the furgeon and his affift-
ants are placed. This was the caufe of the
death of my friend Captain Bayne, of the
Alfred, who having had his knee fo matter-
ed with a round mot that it was neceffary
to amputate the limb, expired under the
operation, in confequence of the weaknefs
induced by lofs of blood in carrying him fo
far. As the Admiral on thefe occafions al-
lowed me the honour of being at his fide, I
carried in my pocket feveral tourniquets of a
iirn .le conitruclion, in cafe that accidents to
atiy perfon on the quarter deck mould have
required their ufe.

Kk 2 It

509 O B S £ & V A T I 0 N S PART III.

- It fometimes happens, however, that no
haemorrhage arifes from a limb being carried
off by a ball. The furgeon of the Fame re-*
l.ated to me an inftance of this, in which the
thigh was cut through by a mot near its up-
per part, all except a little flefh and ikin, and
yet not the leafl haemorrhage followed. This
may have been owing to the limb being en^
tirely fevered, or nearly fo, whereby the
veffels contracted more eafily than if they had
been partially divided. All that was done for
this man was to remove the limb, and to
faw off the jagged end of the bone. He fur-
vived fix days, ftill without bleeding, and
died of the locked jaw.

I was informed by feveral of the furgeons,
that the method of taking up the veffels
by the tenaculum was found to anfwer ex-
tremely well; and many of them imagined
that the locked jaw was not fo apt to be
brought tm by this mode of operation as by
that of the needle. But it is hardly to be
attempted in time of aclion, for want of ftea-
dinefs and a good light, and it was chiefly at

the

CHAP. IV. ON W 0 U » D ». ^OI

the hofpitals that this practice was found fa
fuccefsful.

Mr. Alanfon's method of amputation by
a great retraction of the mufcles, ib that the
flefhy parts fhall meet over the bone and unite
in the firft intention, was attended with
great fuccefs in the Weft Indies, parti-
cularly at the hofpital at St. Lucia, under
the care of Mr. Bulcock.

It may be remarked, that though all fores
and wounds in the foot and leg are difficult
of cure in a hot climate, I have obferved, that
where the constitution is good, thofe in the
thighs, arms, trunk, and head, are rather
more ealy of cure than in Europe, and that
parts divided by incinon very readily unite by
the firft intention. In reafoning Upon this,
ft may be faid, that as healing depends on a
certain degree of vi,gourin the powers of life*
this mould not err either on the fide of excefs
or defect. If it is too great, as in the cafe of
a hale plethoric conftitution in a cold climate*
£00 much inflammation is apt to be excited ;

an&

502 OBSERVATIONS, &C. PART 111.

and if too feeble, as happens in a hot cli-
mate, in the lower extremities, which are
far removed from the fource of life and
circulation, the falutary effort is not ftrong
enough to generate new organiied parts.
But in the trunk cf the body, in fuch a cli-
mate, the powers of the animal ©economy
are in that juft medium which is moil fa-
vourable to this operation of nature.

THE E N a.

INDEX.

.BS OR BENTS ufeful in Fluxes 453, &feq.
Auiion, clofe, the Advantages of it, 98, & fcq.
Air, Superiority of that at Sea, 218. — Noxious EfFe£ts

of it at Land in a hot Climate, £20. — Extent of its

Influence, 221.
Alcide, fickly on the PafTage to America, 34. — Subject

to various Forms of Fevers, 37.
Ailment, want of proper, chief Caufe of Scurvy, 282. —

Increafes the Vigour of the Body in two Ways, 470.
America, North, hotter in Summer than the Weft Indies,

28. — Fleet goes there to avoid the Hurricanes, 33,

144. — Uncommon Seafon there, 151.
Amputation, the Number that died of it at Barbadoes, 184.
Amputation, Mr. Alanfon's Method of performing it, 501.
Anttmoniah, be ft adapted to Biljous Fevers, 391, & feq.

— A Caution with regard to them, 393.

L 1 Army

ii INDEX.

Army at St. Lucia, Difeafes in it, 122. — Mortality in

it, 25, 222.
AJlbma, Climate in the Weft Indies favourable to it, 92.

Barbadoes, more Refreshments at it than any other Ifland,
25. — Ravaged by a Hurricane, 39. — Compofed of coral
Rock, 84.- — Conjecture concerning its Origin, ibid.

■Barfleur, Fevers on Board in Confequence of Recruits
from a French Jail, 136.

Bark, Peruvian, its Effects in preventing Fevers, 223, &
feq. — When uieful in continued Fevers, 375, &?

feV- 394.
Bark, Peruvian, red, fome Account of it, 421.
Barricading a Ship, what meant by it, 19.
Bath, warm, of Ufe in the Dyfentery, 443.— In the

Locked Jaw, 481. — Its proper Temperature, 493.
Battle, the Ardor of, favourable to Health, 20, 75, 96. —

Number killed in, 203, — Lofs in thofe of April, 1782,

479-
Bedding, Utility of airing it, 248.

Bile, a Defect of it in the worft Cafes of Yellow Fever,

399- &'feZ-
Bile, the Marks of a Redundance of it in Dyfynteries,

440. — Its Tendency to prolong Fluxes, 446.
Black Vomit the rnoft dangerous Symptoms in the Yellow

Fever, 401.
Blind'cfs from the Scurvy, 22.
Blijicrs of Ufe in the Ship Fever, 374 — For removing

Irritability of Stomach in the Yellow Fever, 418. —

Of Service in Dyfentery, 443, & fa-

Blood,

INDEX. iii

Blood, a Remark concerning the Buff upon it, 414.
Bloodl tting, Cautions with Regard to it in Ship Fevers,

363. — -In Bilious Fevers, 389.— In the Yellow Fever,

414.
Butter, Objections to its Ufe, 291.

Calomel in certain Cafes the beft Purgative, 392.

Catarrh, tpidem'c, one in Europe affected Men at Sea, 151,
166 — communicated by Strangers, not affected with it
themielves, in one of the Weflern Mauds, 236.

Caufes, a Combination of them neceffary to produce Dif-
eafes, 121.

Chronic Complaints, brought on by Hardship, 212.

Clcanlimfs, the principal Means of Health, 251, 332.

Clothing, its great Influence upon Health, 230.

Clothing fubjedts Man to great Inconvenience, 375— yet
neceffary in all Climates, 316.

Cocoa, fubffituted, with Advantage, for Butter, 293.

Cold hurtful in all Climates, 275.

Coma, a Symptom in the Ship Fever, 350.

Commijfion, Ships long in, moft healthy, 52, 76, 77, 88,
160.

CopperSi, Cautions with Regard to them, 297. — Inftance
of Poifon from neglect of them, 298.

Cordials, a Caution with Regard to them, 382.

Crowding, bad EffecStts of it, 180.

Cruifes to Windward of Martinico, 46, 174. — Near Ja-
maica, 117. — How long they ought to be continued
confident with Health, 127. — A long one off St. Do-
mingo without the Scurvy appearing, 148, &fcq.

L 1 2 Cullen,

iv INDEX.

Cullen, Dr. his Opinion of the Origin of Nervous Fevers,
228. — His great Merit, 409.

Delirium, a remarkable Symptom in the Ship Fever, 350.
— fix; lanation of it, ibid, iff feq. — Means of remov-
ing it, 372, & feq. — Sudden and violent in Bilious
Fevers, 387.

Diaphor'tpCj what fafeft and beft, 369.

Diet, a Table of the daily Allowance of it in the Navy,
292. — A Method of providing what is fuitable to the
Sick. 335.

Diet, a Caution with Regard to it inConvalefcent Fevers,

384.

Diet, what beft in Fluxes, 455, & feq.

Dilution, the great Advantage of it, 370.

Difcipline, Advantage of, to Health, 325, 332.

Dijeafes, Lift of all thofe on Board of the Fleet, 90. —
What Sorts Seamen are moil iubjedt to, and mofl ex-
empt from, 210.

Difeafes acute, tend naturally to wear themfelves out, 67.
—Imputed antiently to fupernatural Influence, 213. —
Owing to Negledl, 214.

Dyfentery depends on the fame Caufe as Fevers, 34.—
Arifes, in the Prince George from cold Weather, 75. —
More fatal in its acute State in a cold thaff a hot Cli-
mate, 149.

DyfntcYy, Appearances upon DifTeclion, 434, & feq.

Earthquakes

N D E X.

Earthquakes frequent in the Weft Indies, 84.
Effluvia, what Kind of them produce Difeafes, 129.
MlephentiafeS) peculiar to Barbadoes, 228.
England, Health of the Fleet there compared to that in

the Weft Indies, 64, & ' fcq. — Fleet there more ftckly

at particular Periods than in the Weft Indies, 201.
Engli/h, their Cleanlinefs only of modern Date, 263.
Erofmus, his Account of the Caufes of peftilential Difeafes

in England, 263.
Exercife, the Advantage of it, 321.
Exercife, in the Sun, very pernicious, 226.
Expeditions, lift of, fruftrated by Difeafe alone, 208.
Etfplqfions of Gunpowder, frequent and deftrudlive, 496.

Means of preventing them, 498.

Fatigue tends to fhorten Life, 323.

Fevers depend on the fame Caufe as Fluxes, 34. — -More

prevalent in Port than Fluxes, 122. — -Aflume a different

Type upon the Importation of Infection, 176. — Diffe-.

rence of its Infection from that of fome other Diitafes,

232, 241.
Fever, Ship, Defcription of it, 349. — Treatment of it,

362.
Fever, inflammatory, principal Symptoms of it, 360.
Fevers, intermittent, fome unufuai Remedies for t! cm,

427, &fq.

L 1 3 Fires,

vi INDEX.

Fires, the moft. effeclual Means of fweetening the Air of
a Ship, 1 12. — The moft powerful Means of deftroying
Infection, 261.

Flow- preferable to Bread for Exportation, 289.

Fluxes depend on the fame Caufe as Fevers, 34. — Prevail
leaft when Fevers moft violent, 42, 108. — Apt to arife
in Ships foon after their Arrival in the Weft Indies, 17,
80. — More frequent at Sea than in Fort, 108. — More
frequent in Ships that have heen Subject to Fevers,
177. — Why fo frequent and fatal at Weil-India Hoipi-
tals, i8oB — Obferyations on them, 429. — -Treatment
of them, 436.

Formidable, extraordinary Degree of Health on Board of
her, 102, 123, 333 — Caufes of it, 69, 103. — Fever
arifes in her from Men lent to another Ship, 123. — -
From preiTed Men, 155.

French Ships, their Difcipline and CEconomy inferior to
Britiih, 109.

Frigates more healthy than Ships of the Line, caufes of
this, 52, & fcq. — More healthy when their Fire Place
was between Decks, 267. — A Contrivance for ven-
tilating them, 271.

Fumigation, Method of performing it, 260, &feq.

Gibraltar relieved by Lord Rodney, 17.— -AdmifTions and

Deaths at the Hofpital there, 180, 199.
Gibraltar Man of War, Account oe her, 51.
Grosijlet Bay, Description of it, 26.'
Gunpowder, Accidents from it, 184, 496, & Jeq,
Guthrie, Dr. his Obfervations on Infection in Ruflia, 280-

Jiabit,

N D E X.* vii

Habit, Effect of it in refitting Infection, 273.

Hemorrhages, internal, Oil and Tinfture of Rhubarb of
eminent Service in them, 449.

Hemorrhage, a Limb fometimes carried off without any
en fuing, 500.

Hard/hip impairs Health and fhortens Life, 21 1.

Harris, Mr, his Treatment of the Locked Jaw, 482. "

Hajlar Hofptal, Proportion of Deaths there, 202.

Heat communicated to the Hand, a Symptom of the Ship
„ Fever, 355.

Hemifphere, Northern, a cold Summer general all over it,
150.

Herodotus, his Account of the Clothing and Health of the
ancient ./Egyptians, 265.
Hofpitals not fo proper for the Sick as their own Ships, 58.
— Account of Difeafes fent to them, 179. — At Gibral-
tar, 180. — At Barbadoes, 183, 191. — At St. Chrifto-
pher's 189. At St. Lucia, ibid. — At Jamaica, 192. —
At New York, 195, fsf fcq. — General View of them
all, 199. — Proportion of Deaths in them no Criterion
of the Succefs of Practice, 194.

Hurricane Months, 26.

Hurricane, a violent one in the Weft Indies, 38— Its good
EftecT: on the H^.'th of the Inhabitants, 30.

Hypachordriac Complaints do not affedf. the laborious Part
of mankind, 210.

l 1 4 y^w*

viit I N D E X.

Jaw, locked, Account of thofe affected by it in the Battles
or April 1782, 479. & fcq- — Its Symptoms different
from thofe of the Tetanus, 485. — Wherefore moll fre-
quent in hot Climates, 488,,

Indolence a Caufe of Scurvy, 322.

Inflexion, the Obfcurity and Difficulty of inveftigating it,
230. — Various Ways in which it is introduced into a
Ship, -233. — It may artfe without the Prefenc-e of Fever,
234. — Habit renders People infenfible to it, 234, &
Jeq.—lt never .ifrrdts all indifcriminately who are ex-
pofed to it, 237 — It does not pafs from one Species of
Animal to another, 239, £s" feq — How to prevent the
Production of it, 244. — Means of eradicating it, 252.,
— Vlethod of guarding againil it, 272. — Lei's frequent
in hot Climates than cold, 278.

Inflammatory Complaints moft frequent in Ships where no
Infection, 166.

Inoculation-, Conjecture concerning the Caufe of its Safety,
238.

Intermittent Fevers fometimes arife on Board of a Ship,
30. — Some unufual Remedies for them, 427.

Inteji'mes, great, the principal Seat of the Dyfentery, 433.

Labour, necefTary to Health, 210. — Pernicious if in Excefs
21 1% — What Difeafes it tends to avert, 212.

Land

INDEX.' ix

Land Wind \ at Jamaica, 115— Not at the fmall Iflands,

ibid.
Lemon Juice, extraordimry Inftance of its Efficacy in.

Scurvy, 81. — The moft effectual Remedy in Scurvy,

285.
Lemons and Limes? their Juice the beft Detergent in fcor-

butic Ulcers, 46$.
Licntery, a Symptom in obftinate Fluxes, 451.
Lime<, Inftance of their great antifcorbutic Effect, 54.
land. Dr. the beft Author in Sea Difeafes, 206. — His

Method of purifvmg Ships, 258.
Liver, Inflammation of it, feldom known in the Weft

Indies, 91. — But appeared at New York in Men be-
longing to the Weft-India Fleet, 150.

Magnejia, given with Acids, removes Sicknefs of the Sto-
mach, ;. 17.

Malt Liquor, the Utility of it, 301,

Malt, EJJence of, a weak Antifcorbutic, 55, 464 — Of Ser-
vi e in the beginning of Scurvy, 141, 159.

Manners, Lord Robert, his Death lamented, 479.

Marjhes, their Exhalations caufe Fevers, 41.

Melajps, Method of ufing it, 287 — jreat Utility of it,
290.

Mixing of Men, bad Confequences of, 243.

Moijhre, the bad Effects of it, 268.

Mortality, Method of calculating the Proportion of it,
86 — (jreater at Sea from the Want of an Hofpital, and
of proper Diet, 137-J-In the Fleets and Hofpitals at

different

x INDEX.

different Periods, 200— In the Army in the Weft In-
dies, ibid — In England, 20 1 — Total in the Fleet for
three Years and three Months, 203.
Mortification, an uncommon Inftance of it in the Shoulder,
81.

Necejfaries, Surgeons, their Quantity very inadequate,

284.
New Tor k, the Fleet there in 1780, 36 — in 1782, 144.
Nyflalopia, a Symptom of the Scurvy, 22, 461.
Nymph, Frigate, Account of her Health, 158.

Oatmeal, the Abufe of it, 289.

Obfervations, the' Difficulty of making them, 8.

Officers, more affected by foul Air than common Men3
in, 131.

Opium, Advantage of combining with Antimonials, 367
— With neutral Salts, 369 — Its Ufe in continued
Fevers, 378, 380 — Cautions and Directions with regard
to it in Fluxes, 441, 445 — Its Ufe in Ulcers, 464 —
The beft Method of giving it in the locked Jaw, 490,
492.

OJbridge, Lieutenant, his ingenious Contrivance for fweet-
euing Water, 311.

Tedi-

N D E X. xi

Pediluvia, hurtful in inflammatory Fevers, 172.

Petechia, a Symptom in the Ship Fever, 354.

Pbthijis pultnonalis, not (o common in the Weft Indies as

Europe, 91 — but more rapid, 92.
Phcewx, ^.panifh Admiral's Ship, her excellent Materials

and Construction, 51.
Pidgeon '[/land, remarkable Proof of its healthinefs, 22.1

Plague, its F'fecTon does not fpread far, ^76. — Means of

preventing it from fpreading, ibid, and 277. — Never

known in tropical Climates, 279.
Porter, its Effedt in preventing Scurvy, 301.
Potatoes, raw, a Remedy for Scurvy, 57= — propofed as an

Article of Victualling, 29 1,
Prudent, Effects of foaking her Timbers in Pickle, 77.
Putrefaction, iimple, Effluvia of it may produce Fevers,

130.

§>uick-Lime, the bell prefervative of Water, 307 &feq.

Recruits new raifed, theCaufe of Sicknefs, 174,
Returns Intention of them 6, 7. — Specimens of them,
21. — Method of forming them into Tables, 22.

Royal

xii INDEX.

Royal Oak, Caufe of her Health, 76.— Method of curing

the Scurvy on Board, 77.
Ruby, remarkably healthy, 160.

St. Lucia, woody, mountainous, and rainy, 25 — Propor-
tion of Deaths at the Hofpital there, 189.

Salt, the good Effects of it in Diet, 295.
Sandwich, Health of^ on her firft arrival, 17.

Scorches, great Numbers killed and wounded in this Man-
ner, 184.

Scurvy, in a Cruife to windward of Martinico, 47— In a
Cruife near Jamaica, 117 — High Degree of it in the
Nonfuch, ibid — On the PafTage to New York, 139—
Why lefs of it in the Ships laft from England, .140—
Its rapid Progrefs in the latter Part of a Cruife, 141
&feq. — Method of curing it on Board of the Fleet at
New York, 144 — Numbers that died of it according
to Sir Richard Hawkins, 208 — In Commodore Anion's
Squadron, ibid.

Scurvy, Obfervations on it, 460 — What meant by the
latent State of it, 465 — The bell Remedies for it, 468

In what Manner the Nature of the Diet induces it,
472 — Whether it is .infectious, 475.
Seafons in the Well: Indies, Account of them, 26 & feq.
Ships, new, not more unhealthy than others, 17, 50 —
Difadvantage in changing their Commanders, 76 —
Why large onesmoft fickly, 123, 127.
Wingle Ballajl, the Advantage of it, 269.
>hoes9 of great Ufe to Seamen, 320.

Sick9

INDEX. xiii

Sick, what the befl: Place for them in a Ship, 250.
Sicknefs, Method of calculating the proportion of it, 86.
Situation., Effects of the Difference of it upon Health, 26.
Small- Pox, very prevalent in the Fleet, 81.
Soap, fupplied on Board of the Fleet, 145 — Its great uti-
lity, 146, 247.
Sour Krout, Manner of ufihg it, 287.
Splinters, moredeftruc"Hve than Balls, 98.
Spices, good againft noxious Air, 225.
Spruce Beer, the great Advantage of it, 302.
Strangers, communicate Difeafe to each other without

any apparent previous Difeafe, 235.
Suffolk Man of War, remarkably afflicted with Fevers,

165.
Surf, Danger from it in watering at St. Lucia, 83.
Surgeons, a greater Proportion of Mortality among them

and their Mates, 128 — Advantage of encouraging

them, 254.
Sweating, of Ufe in curing the Ship Fever, 363 & feq.

—In the Dyfentery, 438.
Sweet Vegetables, more antifcorbutic and medicinal in their

natural State, 56.

Tables, Method of forming them, 86.
Tenaculum, recommended in Amputations, 500.
Thermometer, general Range of it in the Weft Indies, 27

— Obfervations on it at Port Royal, 116.
Tkucyd'ula, his Obfervations on the Plague at Athens,

257-

Ulcers,

xiy I N D E X.

Ulcers, keep Pace with fcorbutic and feverifh Complaints,
126 — Proportion of them, 143 — Very frequent in the
Barfleur, 144 — Great Effect of a cold Climate in di-
minifhing them, 150 — Apt to arife in Scorbutic Ha-
bits, 283, 320, 474.

Uniform for common Seamen recommended, 317.

Union, remarkably healthy, 160 — Subject; only to inflam-
matory Complaints, 166, 275.

Urine, appearance of it in the Yellow Fever, 402, 405.

Vernon, Admiral, Health of his Fleet compared with Lord
Rodney's, 125 — The firfl who caufed the Spirits al-
lowed the Seamen to be diluted, 304 i£ feq.

Vitlory, 1 2th of April 1782, 94 — Its Effects on the
Health of the Men, 96 & fcq.

Vilk de Paris, Sicknefs and Mortality on Board after
being captured, no — Foundered, 203.

Vinegar, Ufe of it in the Navy, 284 — In the Roman Ar-
mies, ibid.

Vitriol, White, ufed as a remedy in intermittent Fevers,
420.

War, why Fleets moft fickly in the beginning of it, 65.
Warren, Dr. his fuccefsful Treatment of a Cafe of the
locked Jaw, 490.

Watery

INDEX. xt

Water of Springs, preferable to running Water, 305 —
Quik-Lime the bell: prefervative of it, 306 — Various
other Means ot correcting it, 309 C£f Jeq. — -Diflilla-
tion from Sea Water recommended, 313.

Watering Duty, dangerous and unwholefome, 83, 113.

Well of a Ship, great Danger of foui Air in it, 266— ■>
Method of preventing it, ibid.

Wind of a Ball, the Effects of it, 405.

Wine, the great Advantage of it in the French Fleet, 303
Tts utility in continued Fevers. 381.

Women, why not fo fubject to acute Difeafes in the Weft
Indies as Men, 226.

Wounds, Number that died of, 203 — Account of thofe re-
ceived in April 1782, 478.

Tarns, ufed in Place of Bread, 74.
Tel low Fever, 396.

Tellownefs of the Skin, not always a Symptom of Malig-
nity, 175.

KBTC", Erfects of it in obftinate intermittent Fevers, 420— »
Cafes in which it is proper, 424 & feq^

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